title: Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention.
abstract: To determine predictors of failure of transradial approach (TRA) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and develop a novel score specific for this population.
  
  
  
  Consecutive patients with STEMI undergoing primary PCI in a tertiary care high-volume radial centre were included. TRA-PCI failure was categorised as primary (primary transfemoral approach (TFA)) or crossover (from TRA to TFA). Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed. Clinical outcomes up to 1 year were assessed.
  
  
  
  From January 2006 to January 2011, 2020 patients were studied. Primary TRA-PCI failure occurred in 111 (5%) patients and crossover to TFA in 44 (2.2%) patients. Independent predictors of TRA-PCI failure were: weight ≤65 kg (OR: 3.0; 95% CI 1.9 to 4.8, p<0.0001), physician with ≤5% TFA conversion (OR: 0.45; 95% CI 0.2 to 0.9, p=0.033), and physician with ≥10% conversion to TFA (OR: 2.2; 95% CI 1.2 to 3.7, p=0.005), intra-aortic balloon pump (OR: 2.0; 95% CI 0.9 to 4.3, p=0.066), cardiogenic shock (OR: 2.8; 95% CI 1.4 to 5.6, p=0.0035), endotracheal intubation (OR: 107; 95% CI 42 to 339, p<0.0001), creatinine >133 μmol/L (OR: 3.6; 95% CI 1.9 to 6.8, p<0.0001), age ≥75 (OR: 1.7; 95% CI 1.0 to 2.9, p=0.031), prior PCI (OR: 2.6; 95% CI 1.5 to 4.5, p=0.0009), hypertension (OR: 1.8; 95% CI 1.2 to 2.9, p=0.009). An integer risk score ranging from -1 to 12 was developed, and predicted TRA-PCI failure from 0% to 100% (c-statistic of 0.868; 95% CI 0.866 to 0.869). Mortality at 1 year remained significantly higher after TRA-PCI failure (adjusted OR 2.2; 95% CI 1.2 to 3.9, p=0.011).
  
  
  
  In a high-volume radial centre, the incidence of TRA-PCI failure is low and can be accurately predicted using a 9-variables risk score. Since outcomes after TRA-PCI failure remained inferior, further effort to maximise the use of radial approach for primary PCI should be investigated.
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: MacHaalany
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barria Perez
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Marie-Pier
authors.initials: MP
authors.lastname: Bouchard
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Roy
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Ugo
authors.initials: U
authors.lastname: Déry
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Larose
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Noël
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011237:Predictive Value of Tests; D011677:Punctures; D011792:Quebec; D017534:Radial Artery / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D062606:Tertiary Care Centers; D013997:Time Factors; D017211:Treatment Failure