Radial vs femoral access after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Thirty-day and one-year mortality results.
OBJECTIVE
Little attention has been given to the effect of vascular access site on mortality, while an increasing body of evidence is showing that radial access has much more benefit than femoral access for ST-segment elevation myocardial infarction patients. We aimed to assess the influence of vascular access site on mortality at 30 days and at 1 year in ST-segment elevation myocardial infarction patients.


METHODS
We included all patients with ST-segment elevation myocardial infarction who had undergone primary angioplasty at 2 Galician hospitals between 2008 and 2010. We performed 2 multivariate regression models for each endpoint (30-day and 1-year mortality). The only difference between these models was the inclusion or not of the vascular access site (femoral vs radial). For each of the 4 models we calculated the Hosmer-Lemeshow test and the C-index. We also tested the interaction between hemodynamic instability and vascular access.


RESULTS
We included 1461 patients with a mean age of 64. Of these patients, 86% had radial access and 7.4% had hemodynamic instability. All-cause mortality was 6.8% (100/1461) at 30 days and 9.3% (136/1461) at 1 year. Vascular access site follows hemodynamic instability and age in terms of effect on mortality risk, with an odds ratio of 5.20 (95% confidence interval, 2.80-9.66) for 30-day mortality. A similar effect occurs for 1-year mortality. The C-index slightly improves (without achieving statistical significance) with the inclusion of the vascular access site.


CONCLUSIONS
Vascular access site should be taken into account when predicting mortality after a primary percutaneous coronary intervention.
Área de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain. Electronic address: alberto.ruano@usc.es.
Alberto
A
Ruano-Ravina
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Guillermo
G
Aldama-López
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Belén
B
Cid-Álvarez
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Pablo
P
Piñón-Esteban
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Diego
D
López-Otero
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Ramón
R
Calviño-Santos
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Raymundo
R
Ocaranza-Sánchez
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Nicolás
N
Vázquez-González
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Ramiro
R
Trillo-Nouche
Subdirección de Calidad, Atención al Paciente y Admisión, Gerencia de Gestión Integrada de Santiago de Compostela, Servicio Gallego de Salud, Santiago de Compostela, A Coruña, Spain.
Estrella
E
López-Pardo
D000368:Aged; D023381:Endpoint Determination; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D016896:Treatment Outcome; D062666:Vascular Access Devices
Cohorte retrospectiva; Infarto de miocardio; Intervención coronaria percutánea; Mortalidad; Mortality; Myocardial infarction; OR; PCI; Percutaneous coronary intervention; Retrospective cohort; ST-segment elevation myocardial infarction; STEMI; odds ratio; percutaneous coronary intervention