title: Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction.
abstract: BACKGROUND
  The transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients>80 years with acute myocardial infarction (MI) undergoing PCI.
  
  
  METHODS
  A total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n=336, 17.3%) was compared with the TF group (n=1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate.
  
  
  RESULTS
  In the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139-0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334-1.240).
  
  
  CONCLUSIONS
  In octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success.
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea. Electronic address: cks@pusan.ac.kr.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jung Cheon
authors.initials: JC
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Han Cheol
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Yun
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Hye Yoon
authors.initials: HY
authors.lastname: Jang
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D057216:Propensity Score; D017534:Radial Artery / Q000601:surgery; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Angioplasty; Myocardial infarction; Octogenarians; Transradial approach