Key result
Transradial primary PCI in acute STEMI was associated with fewer major bleeding complications than the transfemoral approach (P=0.004), with similar major adverse cardiac events at 580 days (P=0.299).
Why the study?
Does primary percutaneous coronary intervention via transradial approach reduce major adverse cardiac events and bleeding complications compared to transfemoral approach in patients with acute ST-elevation myocardial infarction?
Cohort (n=122)
Does primary percutaneous coronary intervention via transradial approach reduce major adverse cardiac events and bleeding complications compared to transfemoral approach in patients with acute ST-elevation myocardial infarction?
p-value: p=0.299
Routine transradial primary PCI in STEMI patients is associated with a significantly reduced rate of major bleeding complications compared to the transfemoral approach, with similar MACE rates.
Transradial primary PCI feasible in STEMI including shock; leaves open need for randomized confirmation of outcomes.
OBJECTIVE: This study investigates the feasibility, efficacy, and safety of routine primary percutaneous coronary intervention via transradial approach in patients with acute ST-elevation myocardial infarction. METHODS AND RESULTS: From 2005 to 2007,122 consecutive patients with acute ST-elevation myocardial infarction within 12 hours, including those experiencing cardiogenic shock, were eligible for primary transradial PCI if the radial artery pulse could be felt. Efficacy, safety, and major adverse cardiac events regarding mortality, recurrent non-fatal myocardial infarction, and revascularization were recorded. Eighty-five of 122 patients underwent transradial PCI, and 37 had transfemoral PCI. Older women, haemodynamic instability, and the presence of severe chronic kidney disease (stages 4 and 5) or end-stage renal disease were significantly related to choice of transfemoral approach (P < 0.05). Glycoprotein IIb/IIIa inhibitors were used more often in patients who underwent transradial PCI than in those who underwent transfemoral PCI (37% vs 16%; P = 0.043). The incidence of major bleeding complications requiring blood transfusion was significantly higher in the transfemoral group (P = 0.004). A similar procedural success rate was achieved in both groups (P = 0.737). During follow-up of 580 days, the total major adverse cardiac events were similar in both groups (P = 0.299). CONCLUSIONS: Routine transradial primary PCI can be safely and successfully performed on up to 70% of acute ST-elevation myocardial infarction patients and, compared with transfemoral approach, is associated with a significantly reduced rate of major bleeding complications.
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Jen et al. (2011) conducted a cohort in acute ST-elevation myocardial infarction (n=122). Transradial primary percutaneous coronary intervention vs. Transfemoral primary percutaneous coronary intervention was evaluated on Total major adverse cardiac events (mortality, recurrent non-fatal myocardial infarction, and revascularization) (p=0.299). Transradial primary PCI in acute STEMI was associated with fewer major bleeding complications than the transfemoral approach (P=0.004), with similar major adverse cardiac events at 580 days (P=0.299).
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