title: Complete transitioning to the radial approach for primary percutaneous coronary intervention: a real-world single-center registry of 1808 consecutive patients with acute ST-elevation myocardial infarction.
abstract: OBJECTIVE
  To compare the short- and long-term outcomes of transradial approach (TRA) versus transfemoral approach (TFA) for primary percutaneous coronary intervention (PPCI) during a complete institutional transition from TFA to TRA.
  
  
  RESULTS
  An all-comer population of ST-elevation myocardial infarction (STEMI) patients (n=1808) who underwent PPCI using TRA (n=1162) and TFA (n=646) from October 2007 to December 2010 were enrolled. TRA was used in 25% of PPCIs by 2007 and in 96% of PPCIs in 2010. Primary endpoints were cardiovascular death and major adverse cardiac event (MACE), defined as a composite of death, stroke, reinfarction, and target vessel revascularization at 30 days and 1 year. At 30 days, TRA compared to TFA was associated with a significant reduction of cardiovascular mortality (5.2% vs 10.5%; P<.001), significant MACE reduction (7.3% vs 12.5%; P<.001), fewer access-site complications (0.9% vs 8.2%; P<.001), and lower TIMI major bleeding (1.1% vs 4.3%; P<.001). At 1 year, the cardiovascular mortality and MACE rates were also in favor of the TRA group (6.9% vs 11.5%; P<.001 and 11.6% vs 20.1%; P<.001), respectively.
  
  
  CONCLUSIONS
  Complete transition from femoral access to a preferred radial access is safe and effective for STEMI patients undergoing PPCI, with a favorable effect on short- and long-term outcomes.
authors.affiliation: University Clinic of Cardiology, Interventional Cardiology, Vodnjanska 17, Skopje, Macedonia 1000. skedev@mt.net.mk.
authors.forename: Sasko
authors.initials: S
authors.lastname: Kedev
authors.forename: Oliver
authors.initials: O
authors.lastname: Kalpak
authors.forename: Surya
authors.initials: S
authors.lastname: Dharma
authors.forename: Slobodan
authors.initials: S
authors.lastname: Antov
authors.forename: Jorgo
authors.initials: J
authors.lastname: Kostov
authors.forename: Hristo
authors.initials: H
authors.lastname: Pejkov
authors.forename: Igor
authors.initials: I
authors.lastname: Spiroski
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D006488:Hemostasis, Surgical; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors