title: Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry.
abstract: OBJECTIVE
  This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice.
  
  
  BACKGROUND
  The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use.
  
  
  METHODS
  Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%).
  
  
  RESULTS
  Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P < 0.001) and vascular access complications (0.3 vs. 1.8%, P < 0.001%) were lower in the TR group. In the multivariate analysis radial access was associated with an improved in-hospital survival rate (OR 0.47, 95% CI 0.35-0.65).
  
  
  CONCLUSIONS
  The radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality.
authors.affiliation: Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.|Universitätsklinik Gießen, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Klinikum Coburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: Klinikum Fulda, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Schächinger
authors.affiliation: Helios-Klinikum Siegburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.affiliation: Krankenhaus Landshut-Achdorf, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.affiliation: Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.affiliation: Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: ST elevation myocardial infarction; acute myocardial infarction; catheterization; coronary artery disease; primary percutaneous coronary intervention; radial access; registry