Safety, feasibility and efficacy of transradial primary angioplasty in patients with acute myocardial infarction.
BACKGROUND
In recent years the transradial approach has been increasingly employed as an alternative approach to percutaneous coronary intervention. The aim of this study was to investigate the safety, feasibility and efficacy of transradial primary angioplasty.


METHODS
We studied 726 patients (552 males, 174 females, mean age 61.5 +/- 12 years) with a diagnosis of acute myocardial infarction (< 12 hours after onset; Killip class 1-3) who underwent primary percutaneous coronary intervention. The transradial approach (group A) was used in 163 consecutive patients (126 males, 37 females, mean age 61.5 +/- 12 years) with a negative Allen test by a single experienced operator. The transfemoral approach (group B) was used for vascular access in the remaining patients (n = 563).


RESULTS
No significant differences in baseline characteristics were observed between the two groups. The radial access was achieved in all patients of group A, but 9 who were switched to either left radial (n = 7) or right femoral approaches (n = 2). The time of radial artery cannulation was in all cases < 2 min. The cannulation time (from skin anesthesia to the time of arterial cannulation) and the total procedure time (from patient arrival at the catheterization room to the completion of the procedure) did not significantly differ between group A and group B (1.7 +/- 0.4 vs 1.6 +/- 0.6 min, p = 0.8; 62 +/- 23 vs 61 +/- 22 min, p = 0.7, respectively). In 71.1% of cases of group A, a single catheter (Sones type I or II) was employed for diagnostic angiography of the right and left coronary arteries and of the left ventricle. Only balloon angioplasty was performed in 6.1% of group A patients vs 9.9% of group B patients (p = NS). The primary success rate was identical: 96.9% in the radial and 95.5% in the femoral group. There were no major bleeding complications in group A as opposed to 7 (1.2%) in group B (p = 0.04). In the radial group patients during the 30-day follow-up period there was no forearm ischemia or loss of the radial pulse. The total length of hospitalization was slightly shorter in the radial group, although this difference was not statistically significant (5.9 +/- 2 vs 6.4 +/- 2.8 days, p = 0.1).


CONCLUSIONS
Provided it is performed by experienced operators, the transradial approach can represent a safe and feasible method for performing primary angioplasty with similar results to those of the transfemoral approach.
Valsecchi
Orazio
O
U.O. Diagnostica ed Interventistica Dipartimento Cardiovascolare Clinico e di Ricerca Ospedali Riuniti Largo Barozzi, 1 24100 Bergamo. ovalsec@tin.it
Musumeci
Giuseppe
G
Vassileva
Angelina
A
Tespili
Maurizio
M
Guagliumi
Giulio
G
Gavazzi
Antonello
A
Ferrazzi
Paolo
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000378:metabolism; D052279:Creatine Kinase, MB Form; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D015995:Prevalence; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D007527:Isoenzymes; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form