Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry

Abstract

Objectives The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. Results During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55–0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25–0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24–0.73, P = 0.002). Conclusions In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

“…The results of our analysis are consistent with earlier clinical practice results in the Czech Republic and other countries [15][16][17][18]. The main reasons for using BMS were the presence of large coronary vessels (requiring implantation of a large stent), ST-elevation myocardial infarction, experience of the operator, costs and reimbursement, regulatory reasons, advanced patient age, and uncertainty regarding the duration of dual antiplatelet therapy, mostly due to higher bleeding risk [19].…”

The benefit and harm of treating STEMI: Between ischemia, bleeding, and reperfusion injury

“…5 At outcome analysis after effective propensity score-adjustment, radial access was independently associated with 30% lower risk of 30-day mortality, and a more than 50% reduction in the risk of clinically relevant in-hospital bleeding and cardiogenic shock. 5 These results from a large unselected STEMI cohort are consistent with those from randomised trials 3,4 and complement available evidence by confirming the benefit of radial access in patients undergoing pPCI in current practice. Given the robustness of data, radial access should remain the default approach, 1 and more efforts should be directed to increase its adoption and ensure proficiency with the procedure.…”

Safety and Efficacy of Four Different Diagnostic Catheter Curves Dedicated to One-Catheter Technique of Transradial Coronaro-Angiography—Prospective, Randomized Pilot Study. TRACT 1: Trans RAdial CoronaryAngiography Trial 1

“…For many years, it was performed mainly from the femoral artery. The radial approach is currently recommended as the first choice for vascular access for this purpose [ 1 ]. Transradial coronary angiography (TRA) was introduced by Campeau in 1989 [ 2 ] and Kiemeneij in 1992 [ 3 ].…”