Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Rathod, Krishnaraj S.; Jones, Daniel A.; Bromage, Daniel I.; Gallagher, Sean M.; Rathod, Vrijraj S.; Kennon, Simon; Knight, Charles; Rothman, Martin T.; Mathur, Anthony; Smith, Elliot; Jain, Ajay K.; Archbold, R. Andrew; Wragg, Andrew
• Is Part Of: Journal of cardiovascular medicine. Volume 16:Issue 3(2015:Mar.)
• Publication Date: 2015-03
• Subjects: access -- femoral -- myocardial infarction -- primary percutaneous coronary intervention -- radial; Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000000230
• Languages: English
• ISSNs: 1558-2027

Abstract

Abstract : Aim: 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. Methods and 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. Conclusion: 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.