title: Results of primary percutaneous coronary intervention in patients ≥75 years treated by the transradial approach.
abstract: Previous trials in elderly patients with ST-elevation myocardial infarction (STEMI) have not shown a definitive benefit of primary percutaneous coronary intervention (PPCI) by transfemoral approach over thrombolysis. The transradial approach (TRA) is associated with a significant decrease in mortality, MACE (Major Adverse Cardiac Event), and serious access site complications compared with the transfemoral approach. We have evaluated clinical outcomes in a cohort of real-life unselected ≥75-year-old patients with STEMI treated by TRA-PPCI. This is a single-center prospective, observational registry of consecutive patients with STEMI who underwent PPCI between February 2007 and February 2013. MACE was defined as death, reinfarction, or stroke. A total of 307 patients were treated by PPCI, 293 (95.1%) with TRA-PPCI (mean age 80 ± 2 years, 42% women). Patients had high co-morbidity levels (cardiogenic shock on admission 8.5%, previous myocardial infarction 11.6%, diabetes 30.4%, previous renal failure 25.6%, previous PCI 9.6%, and peripheral arterial disease 14.3%); IIbIIIa inhibitors were used in 45.1% of patients. Severe bleeding and need for transfusion were recorded for 6.5% and 9.9% of patients, respectively. In-hospital mortality, 1-year mortality, and 1-year MACE were 11.9%, 17.4%, and 22.2%, respectively. Excluding 25 patients with cardiogenic shock on admission, the in-hospital mortality, 1-year mortality, and 1-year MACE were 7.8%, 13.1%, and 17.9%, respectively. In conclusion, TRA-PPCI was feasible in the vast majority of elderly patients with STEMI. In-hospital mortality, 1-year mortality, and 1-year MACE were lower than reported for transfemoral access, suggesting a benefit of the TRA in these patients.
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Spain. Electronic address: oriolrodriguez@gmail.com.
authors: Oriol
authors: O
authors: Rodriguez-Leor
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Eduard
authors: E
authors: Fernandez-Nofrerias
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Xavier
authors: X
authors: Carrillo
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Josepa
authors: J
authors: Mauri
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Carlos
authors: C
authors: Labata
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Carolina
authors: C
authors: Oliete
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors: Maria del Carmen
authors: Mdel C
authors: Rivas
authors: Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Spain.
authors: Antoni
authors: A
authors: Bayes-Genis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome