Radial access versus femoral access in myocardial infarction – a single-center experience

Abstract

Background: Data on the relationship between radial access (RA) and outcome in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) are inconclusive. The aim of our study was to assess whether RA per se is associated with 30-day mortality in patients with MI undergoing percutaneous coronary intervention in our centre or whether the possible benefit of RA is the result of reduced bleeding and/ other confounding factors. Methods: We retrospectively studied 3501 consecutive patients with MI who underwent PCI between January 2012 and December 2016. The 30-day mortality rates in the RA and femoral access (FA) groups were observed. Data were analysed using descriptive statistics. Results: RA patients had a significantly lower 30-day unadjusted mortality [53 (3.8 %) patients died in the RA group compared to 207 (9.8 %) patients in the FA group; p < 0.0001]. After adjusting for confounders, the difference was no longer significant (adjusted OR: 0.84; 95 % CI: 0.58 to 1.22). Cardiogenic shock, age over 70 years, hypertension, hyperlipidaemia, anaemia on admission, renal dysfunction on admission, ST-elevation MI, bleeding, and the contrast volume/ GFR ratio predicted 30-day mortality. However, RA was not found to predict 30-day mortality. Conclusion: RA provides a better 30-day outcome in patients with MI (ST-elevation MI and non--ST-elevation MI) undergoing PCI. However, our result suggests that the better outcome with RA in daily practice in our centre is probably causatively linked to a reduced bleeding rate rather than to RA per se.