Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups.
OBJECTIVE
The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics.


METHODS
We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty.


RESULTS
Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover.


CONCLUSIONS
Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: fhernandezcar@gmail.com.
Francisco J
FJ
Hernández-Pérez
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Ana
A
Blasco-Lobo
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
Leire
L
Goicolea
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Ana
A
Muñiz-Lozano
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
José A
JA
Fernandez-Díaz
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
José R
JR
Domínguez
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Javier
J
Goicolea-Ruigómez
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D016896:Treatment Outcome; D017535:Ulnar Artery; D062666:Vascular Access Devices
Acceso radial; Angioplastia coronaria; Cateterismo cardiaco; Catheterization; Complicaciones; Complication; Coronary angioplasty; PPCI; TFA; TRUA; Transradial approach; primary percutaneous coronary intervention; transfemoral access; transradial/ulnar access