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12.09.2017 | original article | Ausgabe 5-6/2018

Wiener klinische Wochenschrift 5-6/2018

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

A randomized prospective multicenter trial

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 5-6/2018
Autoren:
MD Christiana Schernthaner, MD Matthias Hammerer, MD Stefan Harb, MD Matthias Heigert, MD Kurt Hoellinger, Elisabeth Lassnig, MD Edwin Maurer, MD Jochen Schuler, MD Peter Siostrzonek, MD Hanno Ulmer, MD Andreas Winter, MD Johann Altenberger
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00508-017-1260-5) contains supplementary material, which is available to authorized users.

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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Zusatzmaterial
Supplement Table 4. Percentages of radial vs. femoral access experience of participating operators
508_2017_1260_MOESM1_ESM.docx
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