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Wien Klin Wochenschr. 2018 Mar;130(5-6):182-189. doi: 10.1007/s00508-017-1260-5. Epub 2017 Sep 12.

Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction : A randomized prospective multicenter trial.

Author information

1
Department of Cardiology, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
2
Department of Cardiology, Landeskrankenhaus Graz West, Goestingerstrasse 22, 8020, Graz, Austria.
3
Department of Cardiology, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Austria.
4
Klinikum Kreuzschwestern Wels, Grieskirchnerstrasse 42, 4600, Wels, Austria.
5
Institute of General Practice, Family and Preventive Medicine, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
6
Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria.
7
Department of Cardiology, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria. johann.altenberger@pensionsversicherung.at.
8
Cardiac Rehabilitation Center, Academic Educational Hospital, Paracelsus Medical University Salzburg, Pensionsversicherung, Salzburger Strasse 520, 5084, Großgmain, Austria. johann.altenberger@pensionsversicherung.at.

Abstract

BACKGROUND:

Transradial access (TRA) in percutaneous coronary intervention (PCI) is a widely used standard technique with lower complication rates compared to transfemoral access (TFA). The aim of this study was to evaluate the impact of TRA versus TFA for PCI on clinically significant vascular access complications in the setting of acute myocardial infarction (AMI).

METHODS:

This multicenter study randomly assigned 250 patients in a 1:1 fashion (TRA vs. TFA) admitted with or without ST-segment elevation AMI undergoing immediate PCI. The primary endpoint was defined as the occurrence of hematoma, pseudo-aneurysm or local bleeding at the access site requiring any further intervention and/or prolonged hospital stay. Radiation exposure to the patient and operator was also investigated.

RESULTS:

In the study cohort (N = 250 patients, mean age 62 ± 12.7 years, 76% males) 5 patients (2%) achieved the primary endpoint without a significant difference between groups, 4 out of 125 (3.2%) in the TFA group and 1 out of 125 (0.8%) in the TRA group (p = 0.17). Access site hematoma was significantly more frequent in the TFA group compared to the TRA group (24.8% vs. 8.8%, respectively; p < 0.0007). Local bleeding was only seen in the TFA group (3.2% vs. 0%, p = 0.04). Time intervals from admission to catheter laboratory to first balloon inflation were longer in the TRA compared to the TFA group (34 ± 17 min vs 29.5 ± 13 min, respectively; p = 0.018). Radiation exposure to the patient and operator was identical.

CONCLUSION:

The use of TRA was accompanied by lower rates of access site complications; however, the need for subsequent treatment or prolonged hospital stays was not observed using either of the two access approaches.

KEYWORDS:

Access site; Acute myocardial infarction; Coronary angiography; Hematoma

PMID:
28900715
DOI:
10.1007/s00508-017-1260-5

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