NEW YORK (Reuters Health) – Transradial percutaneous coronary intervention (PCI) for acute MI is associated with a lower risk of major bleeding and other adverse events than transfemoral PCI, a meta-analysis has shown.

“Although transradial PCI is widely applied for percutaneous procedures, its safety in the setting of ST-segment elevation MI (STEMI) is controversial,” Dr. Andras Komocsi, from University of Pecs, Hungary, and colleagues note.

In the present study, reported in the American Heart Journal for November, the researchers conducted a systematic review and meta-analysis to determine how transradial PCI stacks up against transfemoral PCI in patients with acute STEMI.

In searching MEDLINE and other databases from January 1993 to August 2009, the researchers identified 12 studies that met inclusion criteria. Data from 3324 acute MI patients were included in the analysis.

The rate of major bleeding with transradial PCI was significantly lower than with transfemoral PCI: 0.77% vs. 2.61% (p = 0.0001). Transradial PCI was also tied to a lower rate of the composite of death, MI, and stroke: 3.65% vs. 6.55% (p = 0.01). Mortality rates were 2.59% with transradial PCI and 3.18% with transfemoral PCI (odds ratio, 0.54; p = 0.01).

Although procedural time and time to reperfusion did not differ between the two approaches, the fluoroscopy time was significantly longer with transradial PCI and access site crossovers were also more common.

The results, the authors conclude, indicate that “transradial PCI in acute MI improves clinical outcomes by reducing major bleeding and post procedural ischemic complications.”

Reference:
Am Heart J 2009;158:814-821.