Clinical investigation of transradial access for emergent percutaneous coronary intervention in patients with acute myocardial infarction

Abstract

BackgroundUse of intensive anticoagulation and antiplatelet therapy in acute myocardial infarction (AMI) potentially increases the risk of bleeding complications during percutaneous coronary intervention via the transfemoral route. Recently, the transradial access has been intensively employed as an alternative means for diagnostic and interventional procedures. A low incidence of vascular access site bleeding complications suggests that the transradial access is a safe alternative to the transfemoral technique in patients with AMI. The safety and efficacy of transradial access for emergent percutaneous coronary intervention in patients with AMI has not been investigated in the People’s Republic of China.MethodsWe analyzed data from our single-center registry on 596 consecutive patients between October 2003 and October 2010. The patients were retrospectively divided into a transradial group (n = 296) and a transfemoral group (n = 300). A dedicated doctor was appointed to collect the following data: puncture time, coronary angiography time, percutaneous coronary intervention time, X-ray exposure time, duration of hospitalization, and complication rates associated with puncture, such as puncture site bleeding, hematoma, pseudoaneurysm, and major adverse cardiac events.ResultsThere were no significant differences in baseline characteristics and angiographic findings between the two groups. There were also no significant differences in coronary angiography time (8.2 ± 2.4 versus 7.6 ± 2.0 minutes), percutaneous coronary intervention time (30 ± 6.8 versus 29.6 ± 8.1 minutes), or X-ray exposure time (4.6 ± 1.4 versus 4.4 ± 1.3 minutes) between the groups. There were significant differences in puncture time (4.4 ± 1.6 versus 2.4 ± 0.8 minutes) and duration of hospitalization (3.2 ± 1.6 versus 5.4 ± 1.8 days) between the groups (P < 0.001). The complication rate using transradial access was 2.03% (6/296) versus 6.0% (18/300) using transfemoral access (P < 0.0001).ConclusionTransradial access for emergent percutaneous coronary intervention is safe and effective in patients with AMI, and it is suggested that this route could be used more widely in these patients.

The Optimal Arterial Access for Coronary Angiography: Femoral Route versus the Radial Route

“…However more catheters were utilised with the LRA when compared to the right. Overall the LRA approach was found to be as safe as the RRA approach [19][20][21][22].…”

Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis

“…Since then rapid advances in this technique and related devices have catapulted transradial intervention (TRI) to an internationally accepted benchmark and a clinically viable approach to PCIs [8][9][10][11]. A series of studies have demonstrated the superiority of TRI compared to conventional transfemoral intervention (TFI) in terms of reduced risk of adverse outcomes and shorter lengths of hos-pital stays [12][13][14][15][16][17][18][19][20][21][22][23]. A recent Scientific Statement from the American Heart Association highlights these advantages and recommends TRI even in patients with acute coronary syndrome (ACS) [24].…”