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Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction

A randomized prospective multicenter trial

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Summary

Background

Transradial access (TRA) in percutaneous coronary intervention (PCI) is a widely used standard technique with lower complication rates compared to transfemoral access (TFA). The aim of this study was to evaluate the impact of TRA versus TFA for PCI on clinically significant vascular access complications in the setting of acute myocardial infarction (AMI).

Methods

This multicenter study randomly assigned 250 patients in a 1:1 fashion (TRA vs. TFA) admitted with or without ST-segment elevation AMI undergoing immediate PCI. The primary endpoint was defined as the occurrence of hematoma, pseudo-aneurysm or local bleeding at the access site requiring any further intervention and/or prolonged hospital stay. Radiation exposure to the patient and operator was also investigated.

Results

In the study cohort (N = 250 patients, mean age 62 ± 12.7 years, 76% males) 5 patients (2%) achieved the primary endpoint without a significant difference between groups, 4 out of 125 (3.2%) in the TFA group and 1 out of 125 (0.8%) in the TRA group (p = 0.17). Access site hematoma was significantly more frequent in the TFA group compared to the TRA group (24.8% vs. 8.8%, respectively; p < 0.0007). Local bleeding was only seen in the TFA group (3.2% vs. 0%, p = 0.04). Time intervals from admission to catheter laboratory to first balloon inflation were longer in the TRA compared to the TFA group (34 ± 17 min vs 29.5 ± 13 min, respectively; p = 0.018). Radiation exposure to the patient and operator was identical.

Conclusion

The use of TRA was accompanied by lower rates of access site complications; however, the need for subsequent treatment or prolonged hospital stays was not observed using either of the two access approaches.

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Acknowledgements

The authors would like to thank Kristen Kopp for her help in language editing of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria

    Christiana Schernthaner MD, Matthias Hammerer MD, Matthias Heigert MD, Jochen Schuler MD & Johann Altenberger MD

  2. Institute of General Practice, Family and Preventive Medicine, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria

    Jochen Schuler MD

  3. Klinikum Kreuzschwestern Wels, Grieskirchnerstrasse 42, 4600, Wels, Austria

    Elisabeth Lassnig & Edwin Maurer MD

  4. Department of Cardiology, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Austria

    Kurt Hoellinger MD, Peter Siostrzonek MD & Andreas Winter MD

  5. Department of Cardiology, Landeskrankenhaus Graz West, Goestingerstrasse 22, 8020, Graz, Austria

    Stefan Harb MD

  6. Cardiac Rehabilitation Center, Academic Educational Hospital, Paracelsus Medical University Salzburg, Pensionsversicherung, Salzburger Strasse 520, 5084, Großgmain, Austria

    Johann Altenberger MD

  7. Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria

    Hanno Ulmer MD

Authors
  1. Christiana Schernthaner MD
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  2. Matthias Hammerer MD
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  7. Edwin Maurer MD
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  10. Hanno Ulmer MD
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  11. Andreas Winter MD
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  12. Johann Altenberger MD
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Corresponding author

Correspondence to Johann Altenberger MD.

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Conflict of interest

C. Schernthaner, M. Hammerer, S. Harb, M. Heigert, K. Hoellinger, E. Lassnig, E. Maurer, J. Schuler, P. Siostrzonek, H. Ulmer, A. Winter, and J. Altenberger declare that they have no competing interests.

Ethical standards

All studies on human participants reported in this article were carried out with the approval of the responsible ethics committees and in accordance with national law and the Helsinki Declaration form 1964 (in its current revised form). Informed consent was obtained from all participants in the study.

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Schernthaner, C., Hammerer, M., Harb, S. et al. Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction. Wien Klin Wochenschr 130, 182–189 (2018). https://doi.org/10.1007/s00508-017-1260-5

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