Key result
Radial-to-femoral crossover during primary PCI is linked to delayed door-to-balloon times and ~3-fold higher mortality.
Why the study?
Radial access has fewer access site complications than femoral access but prolongs door-to-balloon time because of higher rates of failure and crossover.
Does crossover from radial to femoral access during primary PCI affect door-to-balloon time and in-hospital mortality compared to successful radial access?
Cohort (n=3,600)
Does crossover from radial to femoral access during primary PCI affect door-to-balloon time and in-hospital mortality compared to successful radial access?
Absolute Event Rate: 5.4% vs 1.8%
p-value: p=0.020
Crossover from radial to femoral access during primary PCI is associated with delayed door-to-balloon time and increased in-hospital mortality, with female sex and anterior MI identified as primary predictors.
Cautions against unguided radial-first attempts in primary PCI; leaves open whether predictor-guided access reduces mortality.
Access site complications are more common with femoral access (FA) than radial access (RA). However, due to the higher rate of failure and crossover, door-to-balloon time (DBT) is prolonged by RA. Records of 3600 patients who underwent primary percutaneous coronary intervention (pPCI) between January 2016 and June 2019 were retrospectively reviewed. A total of 130 patients with crossover from RA to FA were identified and compared with the data of 501 patients who underwent pPCI with successful RA during 2018. Regression analysis was performed to determine the predictors of crossover. Crossover to the femoral approach occurred in 5.9% of our cases. Mean DBT was 17 minutes longer in the crossover group (61 ± 72 minutes vs 78 ± 79 minutes, P = .026). Female sex (odds ratio [OR]: 1.8; 95% CI, 0.99-3.46, P = .046) and anterior myocardial infarction (AntMI; OR: 0.52; 95% CI, 0.33-0.88, P = .007) were independent predictors of crossover. In-hospital mortality rates were significantly higher in the crossover group than in the radial success group (5.4% vs 1.8%, P = .020). Crossover to FA due to radial failure is associated with delayed DBT and increased rate of in-hospital mortality. Female sex and AntMI were primary predictors of crossover.
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Şahinkuş et al. (2020) conducted a cohort in Primary percutaneous coronary intervention (n=3,600). Crossover from radial to femoral access vs. Successful radial access was evaluated on In-hospital mortality (p=0.020). Crossover from radial to femoral access during primary PCI was associated with delayed door-to-balloon time and higher in-hospital mortality compared to successful radial access (5.4% vs 1.8%, P=0.020).
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