title: Efficacy of the radial approach for the performance of primary PCI for STEMI.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is associated with increased bleeding complications, impacting clinical outcome. Transradial PPCI could decrease the risk of bleeding, but concerns about technical difficulties and longer reperfusion times limit its adoption.
  
  
  OBJECTIVE
  This was a retrospective comparison of reperfusion times and bleeding complications in a large cohort of STEMI patients treated by PPCI through the transradial (TR; n = 244) or transfemoral approach (TF; n = 364) from January 2005 to December 2009. Endpoints were door-to-balloon time, access-site and non-access site bleeding, as well 1-month and 1-year mortality rates.
  
  
  RESULTS
  Patients treated with TR-PPCI were younger than those having TF-PPCI, (57 ± 13 years vs 62 ± 13 years, respectively; P<.01), more frequently males (84% vs 73%, respectively; P<.01), and had less renal failure (9% vs 16%, respectively; P<.01) or hemodynamic compromise, ie, pulmonary edema or cardiogenic shock (1% vs 4%, respectively; P=.01). Angiographic and angioplasty characteristics, including the angiographic success rate, were similar, with the exception of a higher use of aspiration devices in the TR-PPCI group (31% vs 15%, respectively; P<.01). The door-to-balloon time was similar in both groups (76 ± 40 minutes vs 74 ± 41 minutes; P=NS). Significant lower rates of overall bleeding (6% vs 31%; P<.01), access-site bleeding (4% vs 27%; P<.01), non-access site bleeding (1% vs 3%; P=.01) and need for blood transfusion (0% vs 3%; P=.01) were observed in the TR-PPCI group. One-month (3% vs 7%; P<.05) and 1-year mortality rates (4% vs 11%; P<.05) were lower in the TR-PPCI group. Radial PCI was an independent predictor of 1-year mortality.
  
  
  CONCLUSIONS
  TR-PPCI is feasible in STEMI patients and can be performed efficiently within the time limits recommended. This approach provides advantages in terms of reduction of bleeding that could translate into an improved clinical outcome.
authors.affiliation: Cardiology Department, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel. drcarloscafri@gmail.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Cafri
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Miriam
authors.initials: M
authors.lastname: Merkin
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Weinstein
authors.forename: Sergio
authors.initials: S
authors.lastname: Kobal
authors.forename: Reuvem
authors.initials: R
authors.lastname: Ilia
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D006439:Hemodynamics / Q000502:physiology; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome