Radial versus femoral access for percutaneous coronary intervention in ST-elevation myocardial infarction patients treated with fibrinolysis: Results from the randomized routine early invasive clinical trials.
BACKGROUND
To investigate the relationship between arterial access site choice (radial versus femoral) and clinical outcomes among STEMI patients undergoing routine PCI after fibrinolysis.


METHODS
Patient-level data from trials of STEMI patients evaluating routine PCI after fibrinolysis were included. The primary endpoint was 30-day major bleeding; secondary endpoints included 30-day death and re-infarction.


RESULTS
1891 patients underwent PCI (trans-radial n=338, trans-femoral n=1553). Trans-radial PCI patients were less likely to be >75years (2% vs. 8%, p=0.0001), heavier (median weight 82 [72-90] vs. 80 [70-90] kg, p=0.0013) and more likely in Killip class I at presentation (87% vs. 82%, p=0.03). At 30days, trans-radial PCI was associated with a similar unadjusted risk for major bleeding (3.7% vs. 1.2%, Odds Ratio [OR] 0.43 [95% CI 0.13-1.48], p=0.18), mortality (3.4% vs. 1.2%, OR 0.34 [0.09-1.28], p=0.11) and re-infarction (3.9% vs. 4.7%, OR 1.25 [0.60-2.58], p=0.56). In multivariable analysis, radial access was associated with similar estimates for bleeding and death/reinfarction risk.


CONCLUSIONS
In STEMI patients treated with fibrinolysis and undergoing an early routine invasive strategy, radial compared to femoral PCI is chosen in younger, less ill patients and is independently associated with similar risk of bleeding, re-infarction, and mortality.


CONCLUSIONS
This study evaluated the relationship between arterial access choice (radial versus femoral) and in-hospital and 30-day outcomes in patients undergoing routine PCI after fibrinolysis for STEMI. We included patient-level data from trials evaluating a strategy of routine PCI after fibrinolysis for STEMI. Of 1891 patients undergoing PCI, trans-radial access (n=338) was chosen in younger, lower risk patients. At 30days, trans-radial access was associated with a similar unadjusted and adjusted risk of major bleeding, re-infarction and mortality.
Terrance Donnelly Heart Centre, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
John J
JJ
Graham
Terrance Donnelly Heart Centre, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
Andrew T
AT
Yan
Canadian Heart Research Centre, Toronto, Canada.
Mary K
MK
Tan
University of Toronto, Toronto, Canada; Southlake Regional Health Centre, Newmarket, Canada.
Warren J
WJ
Cantor
Royal Brompton Hospital and Imperial College, London, United Kingdom.
Carlo
C
DiMario
Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
Sanjit S
SS
Jolly
Oslo University Hospital Ulleval, Oslo, Norway.
Sigrun
S
Halvorsen
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Francisco
F
Fernandez-Aviles
University of Ottawa Heart Institute, Ottawa, Canada.
Michel R
MR
Le May
Innere Medizin III, Universitat des Saarlandes, Homburg, Germany.
Bruno
B
Scheller
Federico II University, Naples, Italy.
Francesco
F
Borgia
University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Federico
F
Piscione
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Mina
M
Madan
Terrance Donnelly Heart Centre, St. Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada; Canadian Heart Research Centre, Toronto, Canada. Electronic address: goodmans@chrc.net.
Shaun G
SG
Goodman
D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005263:Femoral Artery / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
Bleeding; Fibrinolysis; PCI; Radial access