title: Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.
abstract: OBJECTIVE
  To compare long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) using radial and femoral arterial access.
  
  
  RESULTS
  The present study was an observational cohort study of patients with STEMI treated consecutively with PPCI between 2004 and 2011 at a single centre. The primary end point was all-cause mortality at a median follow-up of 3 years.Among 2727 patients, 1600 (58.7%) underwent PPCI via the femoral route. The femoral group was older (64.7 vs. 61.7 years; P < 0.0001), and had higher rates of diabetes (18.6% vs. 16.0%; P < 0.0001), previous PCI (11.2 vs. 7.8%; P = 0.004), previous myocardial infarction (15.3 vs. 8.3%; P < 0.0001) and cardiogenic shock (9.8 vs. 1.3%; P < 0.0001). Bleeding complications were more frequent in the femoral group (4.7 vs. 1.2%; P < 0.0001). The 5-year death rate was significantly higher in the femoral group than in the radial group (10.4 vs. 3.0%; P < 0.0001). After adjustment for confounding variables, bleeding complications [heart rate 2.07 (95% confidence interval 1.05-4.08)] and femoral access [heart rate 1.60 (95% confidence interval 1.02-2.53)] were independent predictors of all-cause mortality. After stratification using the propensity score, excess long-term mortality in patients treated via the femoral approach was predominantly in patients with a high baseline risk of death.
  
  
  CONCLUSIONS
  Patients undergoing PPCI via the femoral route are at a higher risk of adverse short-term and long-term outcomes than patients undergoing PPCI via the radial route. Patients with a high baseline risk may benefit most from radial access, and future outcome studies should focus on the most at-risk patients.
authors: aDepartment of Cardiology, London Chest Hospital bDepartment of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University cNIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
authors: Krishnaraj S
authors: KS
authors: Rathod
authors: Daniel A
authors: DA
authors: Jones
authors: Daniel I
authors: DI
authors: Bromage
authors: Sean M
authors: SM
authors: Gallagher
authors: Vrijraj S
authors: VS
authors: Rathod
authors: Simon
authors: S
authors: Kennon
authors: Charles
authors: C
authors: Knight
authors: Martin T
authors: MT
authors: Rothman
authors: Anthony
authors: A
authors: Mathur
authors: Elliot
authors: E
authors: Smith
authors: Ajay K
authors: AK
authors: Jain
authors: R Andrew
authors: RA
authors: Archbold
authors: Andrew
authors: A
authors: Wragg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D017534:Radial Artery / Q000601:surgery*; D016896:Treatment Outcome