NEW YORK (Reuters Health) – For primary percutaneous coronary intervention for ST-segment elevation MI, access via the radial artery is associated with better outcomes than is the femoral route, according to the results of a meta-analysis reported in the American Journal of Cardiology online December 26
“When feasible, the radial approach should be the favored route in primary PCI,” the Canadian authors conclude.
Dr. Dominique Joyal, with Jewish General Hospital/McGill University in Montreal, Quebec, and colleagues note that PCI via the radial approach is associated with less bleeding than femoral access, and that this might be particularly advantageous in primary PCI. To look into this, they performed a meta-analysis of ten randomized controlled trials involving 3347 STEMI patients.
There were significantly fewer total deaths within 30 days in the radial access group (28) than in the femoral group (54), resulting in a short-term mortality odds ratio of 0.53, the team found.
Corresponding numbers of major bleeding events were 18 versus 33 (odds ratio 0.63), but this difference was not statistically significant, the report indicates. However, the rate of vascular complications/hematoma was significantly reduced with the radial approach compared to the femoral route (odds ratio 0.35).
The authors point out that radial access is technically more challenging than the femoral approach. However, in the current analysis, the mean procedural time with the radial route was only 1.76 minutes longer than with femoral access.
Dr. Joyal and colleagues note that bias or chance could have influenced their results since blinding was not possible in the trials, and “the generalizability of the findings might not be applicable to most cardiac catheterization centers lacking experience in radial procedures.”
That said, they conclude, “The current body of evidence suggests that in experienced hands, the radial approach should be the favored route for primary PCI.”
SOURCE:
Am J Cardiol 2012.
