Transradial approach for coronary angioplasty in the setting of acute myocardial infarction: a dual-center registry.
Although transradial angioplasty has been shown to have no major entry site-related complications, its clinical applicability for balloon angioplasty and stenting in acute myocardial infarction (AMI) is unclear. In order to assess the feasibility, safety, and clinical outcome of transradial access for coronary angioplasty (PTCA) and stenting during AMI, transradial angioplasty for AMI was registered on a prospective database at two European sites (A and B) with experience in the radial approach (RA); 6 Fr catheters with an inner lumen of at least 0.064" and low-profile rapid-exchange balloons were used. Primary success rates and procedural complications of 6 Fr RA were determined and compared to 6 Fr femoral approach (FA) procedures. A total of 1,224 AMI patients entered the registry. Study site A enrolled 185 RA patients (13.6% AMI) and study site B 92 RA patients (63.4%). Patient baseline demographics were similar in both study centers and showed no differences between RA and FA patients, except a more frequent use of abciximab in study site B compared to A. PTCA was successful in > 95% of both RA and FA patients. Total procedural time did not differ between RA and FA patients. Severe access site-related bleeding complications, however, were observed in FA patients only: study site A used closure devices routinely and found 2% severe bleedings; study site B used no closure device for FA patients and observed 7% severe bleedings. In selected patients and in experienced hands, transradial PTCA in AMI has a high success rate, is clinically safe, and could become an attractive alternative access site for patients being at high or even low risk for bleeding complications.
Louvard
Yves
Y
Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacquer Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France. y.louvard@icps.com.fr
Ludwig
Josef
J
Lefèvre
Thierry
T
Schmeisser
Alexander
A
Brück
Martin
M
Scheinert
Dierk
D
Loubeyre
Christophe
C
Klinghammer
Lutz
L
Morice
Marie-Claude
MC
Flachskampf
Frank A
FA
Daniel
Werner G
WG
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012042:Registries; D015607:Stents; D016896:Treatment Outcome