title: Effect on bleeding, time to revascularization, and one-year clinical outcomes of the radial approach during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
abstract: The radial approach during percutaneous coronary intervention (PCI) has been reported to reduce the incidence of bleeding complications. However, the radial approach still accounts for <10% of procedures worldwide and only 1% in the United States. Our objective was to compare the effect of radial versus femoral vascular access on the time to reperfusion, incidence of bleeding complications, and overall clinical outcomes in the setting of primary PCI. We prospectively collected data on all patients undergoing primary PCI at the Montreal Heart Institute from April 1, 2007 to March 30, 2008. The time to revascularization and major bleeding were prespecified as a co-primary end point, and major adverse cardiac events, including death, myocardial infarction, and target vessel revascularization within 12 months, were considered a secondary end point. A total of 489 patients were included in the present longitudinal cohort study, 234 in the femoral group and 254 in the radial group. In the propensity-adjusted model, the use of the femoral approach was a strong independent predictor of bleeding (odds ratio 4.22, 95% confidence interval 3.17 to 10.60). No significant difference between the radial and femoral groups was observed relative to the time to revascularization (21.4 +/- 11.8 minutes vs 22.8 +/- 10.3 minutes, respectively; p = 0.68). Moreover, the radial approach was associated with a decreased risk of major adverse cardiac events (odds ratio 0.31, 95% confidence interval 0.10 to 0.94). In conclusion, primary PCI using the radial approach was associated with a fourfold reduction in major bleeding, without compromising the time to revascularization. Moreover, the radial approach was associated with a significant reduction in major adverse cardiac events at 12 months.
authors.affiliation: Division of Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Dabit
authors.initials: D
authors.lastname: Arzamendi
authors.forename: Hung Quoc
authors.initials: HQ
authors.lastname: Ly
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
authors.forename: Mark Yan Yee
authors.initials: MY
authors.lastname: Chan
authors.forename: Pierre
authors.initials: P
authors.lastname: Chevallereau
authors.forename: Richard
authors.initials: R
authors.lastname: Gallo
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Philippe
authors.initials: P
authors.lastname: L'Allier
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gosselin
authors.forename: Pierre
authors.initials: P
authors.lastname: Deguise
authors.forename: Michel
authors.initials: M
authors.lastname: Joyal
authors.forename: Jean
authors.initials: J
authors.lastname: Gregoire
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
authors.forename: Jacques
authors.initials: J
authors.lastname: Crepeau
authors.forename: Serge
authors.initials: S
authors.lastname: Doucet
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017534:Radial Artery; D013997:Time Factors; D016896:Treatment Outcome