Effects of radial versus femoral artery access in patients with acute myocardial infarction: A large centre prospective registry

Abstract

Aim This study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access. Methods This is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30- day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison. Results Retrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77% of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7% vs. 6.7%, p < 0.001), and Killip class (Killip 1: 10.8% vs. 17.3%, p < 0.001). 30-day mortality rates were 1.7% in the transradial group and 4.6% in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30- day mortality in the transradial group was 0.56 (95% CI: 0.29-1.07, p = 0.08). Conclusion This registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.