Clinical Outcomes and Associations With Radial to Femoral Crossover in ST-Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Radial access is recommended for primary percutaneous coronary intervention (PCI) due to lower mortality and bleeding risks compared to femoral access.
• Despite its benefits, radial access failure can necessitate crossover to femoral access, impacting patient outcomes.

Purpose of the Study:

• To identify factors associated with radial-to-femoral access crossover in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI.
• To compare clinical outcomes between patients who required crossover and those who did not.

Main Methods:

• Retrospective analysis of 1,202 STEMI patients undergoing primary PCI between 2016 and 2021.
• Identification of independent predictors for radial-to-femoral access crossover.
• Comparison of access site complications, length of stay, and mortality rates.

Main Results:

• Radial access was utilized in 94.7% of patients; 5.3% required crossover to femoral access.
• Crossover patients experienced higher rates of access site complications, longer hospital stays, and increased inpatient mortality.
• Independent predictors of crossover included cardiogenic shock, pre-catheterization cardiac arrest, and prior coronary artery bypass grafting (CABG).
• Higher biochemical infarct size and peak creatinine levels were observed in the crossover group.

Conclusions:

• Crossover from radial to femoral access in STEMI primary PCI is associated with significantly worse clinical outcomes.
• Factors like cardiogenic shock, cardiac arrest, and prior CABG predict the need for crossover.
• Minimizing crossover is crucial for improving patient safety and reducing healthcare resource utilization.