title: Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: changing patterns of vascular access, radial versus femoral artery.
abstract: OBJECTIVE
  To examine the safety and efficacy of emergency transradial primary percutaneous coronary intervention for ST-elevation myocardial infarction.
  
  
  METHODS
  Single-centre observational study with prospective data collection.
  
  
  METHODS
  A regional cardiac centre, United Kingdom.
  
  
  METHODS
  1051 consecutive patients admitted with ST-elevation myocardial infarction, without cardiogenic shock, between November 2004 and October 2008.
  
  
  METHODS
  Percutaneous coronary interventions by radial and femoral access
  
  
  METHODS
  The primary outcome measures were procedural success, major vascular complication and failed initial access strategy. Secondary outcomes were in-hospital mortality and major adverse cardiac and cerebrovascular events, needle-to-balloon times, contrast volume used, radiation dose absorbed and time to discharge. Multiple regression analysis was used to adjust for potential differences between the groups.
  
  
  RESULTS
  571 patients underwent radial access and 480 femoral. A variable preference for radial access was observed among the lead operators (between 21% and 90%). Procedural success was similar between the radial and femoral groups, but major vascular complications were more frequent at the site of femoral access (0% radial versus 1.9% femoral, p = 0.001). Failure of the initial access strategy was more frequent in the radial group (7.7% versus 0.6%, p<0.001). Adjustment for other procedural and clinical predictors did not alter these findings. Needle-to-balloon time, as a measure of procedural efficiency, was equal for radial and femoral groups.
  
  
  CONCLUSIONS
  In the setting of acute ST-elevation myocardial infarction without cardiogenic shock, transradial primary angioplasty is safe, with comparable outcomes to a femoral approach and a lower risk of vascular complications.
authors: Department of Cardiology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK.
authors: S L
authors: SL
authors: Hetherington
authors: Z
authors: Z
authors: Adam
authors: R
authors: R
authors: Morley
authors: M A
authors: MA
authors: de Belder
authors: J A
authors: JA
authors: Hall
authors: D F
authors: DF
authors: Muir
authors: A G C
authors: AG
authors: Sutton
authors: N
authors: N
authors: Swanson
authors: R A
authors: RA
authors: Wright
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D017534:Radial Artery; D016896:Treatment Outcome