Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI Trial

Abstract

Objective: To compare bleeding complications and results of percutaneous coronary intervention (PCI) between patients treated by radial and femoral approaches for acute myocardial infarction (AMI,) and using abciximab and 5 French guiding-catheters. Patients: 114 consecutive patients with AMI were prospectively randomised. Exclusion criteria were a history of coronary artery bypass graft, cardiogenic shock, atrioventricular block, and contraindication to abciximab or a negative Allen test. Local haemostasis was achieved by manual compression. Results: Baseline characteristics were similar between the two groups. Peripheral arterial complication rates and delays to patient ambulation were significantly lower in the radial group than in the femoral group, whereas inhospital stay was similar between the two groups. A cross over was more often necessary in the radial group than in the femoral group. Coronary angiography duration and fluoroscopy time were significantly longer in the radial group than in the femoral group, whereas PCI duration was similar in both groups. Conclusions: The FARMI trial showed that the radial route lowered peripheral arterial complication rates and allowed earlier ambulation, despite no significant benefit on the duration of hospitalisation.

Transradial versus transfemoral approach for percutaneous coronary procedures

“…It included 114 patients presenting with acute myocardial infarction with a negative Allen's test and not in cardiogenic shock. The study found lower peripheral arterial complications with earlier deambulation in the TRA group, despite a slightly higher crossover rate and angiography and fluoroscopy time, with similar PCI duration and length of hospital stay [30]. In addition, in older adults (> 70 years of age) with acute myocardial infarction, TRA showed similar success with similar door-to-balloon time (except for the small percentage of patients in which crossover was necessary) and significantly fewer vascular complications [31].…”

Blood Transfusion After Myocardial Infarction

“…Peripheral arterial disease is strongly associated with baseline anemia (1); therefore, the radial access appears particularly attractive in these patients (1). This route, initially reserved for elective patients, is increasingly used in selected patients undergoing primary angioplasty (12).…”

2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes (ACS) 2006

“…An estimated 33% of patients with ACS have creatinine clearance <60 mL/min [46]. Access via the radial artery during PCI has been shown to reduce the rate of severe bleeding, compared with femoral artery access [47,48].…”