Transradial versus transfemoral intervention for acute myocardial infarction: a propensity score-adjusted and -matched analysis from the REAL (REgistro regionale AngiopLastiche dell'Emilia-Romagna) multicenter registry.
OBJECTIVE
This study sought to assess whether transradial intervention, by minimizing access-site bleeding and vascular events, improves outcomes in patients with ST-segment elevation myocardial infarction compared with the transfemoral approach.


BACKGROUND
Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty.


METHODS
We identified all adults undergoing percutaneous intervention for acute myocardial infarction in Emilia-Romagna, a region in the north of Italy of 4 million residents, between January 1, 2003, and July 30, 2009, at 12 referral hospitals using a region-mandated database of percutaneous coronary intervention procedures. Differences in the risk of death at 2 years between patients undergoing transfemoral versus transradial intervention, assessed on an intention-to-treat basis, were determined from vital statistics records and compared based on propensity score adjustment and matching.


RESULTS
A total of 11,068 patients were treated for acute myocardial infarction (8,000 via transfemoral and 3,068 via transradial route). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for the transradial than for the transfemoral group (8.8% vs. 11.4%; p = 0.0250). The rate of vascular complications requiring surgery or need for blood transfusion were also significantly decreased in the transradial group (1.1% vs. 2.5%, p = 0.0052).


CONCLUSIONS
In patients undergoing angioplasty for acute myocardial infarction, transradial treatment is associated with decreased 2-year mortality rates and a reduction in the need for vascular surgery and/or blood transfusion compared with transfemoral intervention.
Institute of Cardiology, University of Ferrara, Ferrara, Italy. vlgmrc@unife.it
Marco
M
Valgimigli
Francesco
F
Saia
Paolo
P
Guastaroba
Alberto
A
Menozzi
Paolo
P
Magnavacchi
Andrea
A
Santarelli
Francesco
F
Passerini
Pietro
P
Sangiorgio
Antonio
A
Manari
Fabio
F
Tarantino
Massimo
M
Margheri
Alberto
A
Benassi
Massimo Giuseppe
MG
Sangiorgi
Stefano
S
Tondi
Antonio
A
Marzocchi
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D013223:Statistics as Topic