Outcomes Utilizing Femoral Access Compared to Radial Access for Percutaneous Coronary Intervention in Patients Presenting with ST Elevation Myocardial Infarction in a Single Center with High STEMI Volumes
Background:
Randomized controlled trials have demonstrated that percutaneous coronary intervention (PCI) utilizing radial artery access (TR) is superior to PCI utilizing femoral artery access (TF) with regard to bleeding and mortality in patients with ST elevation myocardial infarction (STEMI). However, the number of patients enrolled from individual centers in the multicenter trials are relatively small, and several trials did not control for operator or institutional experience with access or post procedure care.
Methods:
Retrospective analysis of outcomes in patients with STEMI undergoing primary PCI in a single hospital with high STEMI volume (>250/year), high operator STEMI volume (>30/year), and high operator volume for both radial and femoral access (>500 career cases for both approaches).
Results:
689 consecutive patients (69.5% male) who had primary PCI for STEMI without cardiogenic shock and/or need for mechanical circulatory support between January 1, 2015 through December 31, 2017 were included. TR was used in 45% of patients, with 1.3% crossover to TF. Patients receiving TF approach were older (63 vs 61 years, p=0.023) and had smaller body mass index (29.1 vs 30.9 kg/m2, p=0.016) compared to patients receiving TR. More males received TR compared to females (48% vs 39.5%, p=0.048). 50 out of 57 patients with prior CABG received TF approach (87.8%, p<0.001). No significant differences were seen between TF and TR approaches for cath lab arrival to balloon/device time (23.3 vs 22.4 minutes, p=0.11), in-hospital mortality (0.80% vs 0.96%, p=1), TIMI major bleeding (0.80% vs 0.32%, p=0.75), blood transfusions (0.53% vs 0.96%, p=0.84) or length of stay (3.23 vs 2.98 days, p=0.178). TIMI minor bleeding occurred more frequently with TF compared to TR (5.59% vs 2.22%, p=0.043).
Conclusions:
In patients undergoing primary PCI for STEMI without shock or need for mechanical circulatory support, both TF and TR approaches to primary PCI may be performed safely, with TR reducing TIMI minor bleeds, but not affecting mortality or TIMI major bleeds in our high volume STEMI center with operators facile at both approaches and post procedure care familiar with the care of both access sites.