A-9 | The debate continues - femoral vs radial access amongst ST elevation myocardial infarctions in a community setting

Both the RIVAL and the MATRIX studies demonstrated that radial access in cardiac catheterizations were associated with lower adverse events compared to femoral access. On the other hand, a subgroup of low to intermediate proportion of radial approach PCIs found marginal benefits in radial vs femoral approach, which suggest that outcomes can be operator dependent due to proficiency and preference. Current guidelines promote radial access as a class 1 recommendation amongst patients undergoing PCI in acute ACS. Therefore, our study aims to compare the outcomes and complication rates for the radial vs femoral approach amongst patients admitted for an acute STEMI. This was a single center retrospective observational study of arterial access in patients presenting with STEMI between 2021 to 2023. Important outcomes included death, vascular complications, aborted procedures, cardiac arrest, and renal dysfunction. We excluded patients with prior CABG and those presenting with cardiogenic shock. Chi-squared analysis was performed to determine significance in differences of outcomes. Of 446 patients undergoing PCI for STEMI, 207 had femoral access while 239 had radial access. 32 (15.5%) had aborted radial approach and crossed over to femoral access. With approximately equal numbers in each group, there does not appear to be a definitive preference of vascular access at our institution. There were no significant differences between radial and femoral access in the development of access site hematomas (0.4% vs 2.4%, p = 0.997) or need for resuscitation due to cardiac arrest (0.4% vs 2.9%, p = 0.986). Interestingly, patients with radial access when compared to femoral access had less deaths (2.5% vs 9.7%, p = 0.002), lower risk of AKI (5.4% vs 11.6%, p = 0.016), and higher rates of successful PCI (94.9% vs 85.5%, p = 0.002). Our study results confer with current guidelines in reduction of mortality and AKI except for non-inferiority in hematoma formation in both approaches. Adoption by interventionalists at community hospitals have been trailing behind, possibly due to operator preference and comfort level.