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Primary PCI with radial access seen preferable to femoral approach

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Results of primary percutaneous intervention (PCI) in patients with ST-segment elevation MI are better when the procedure is performed via the radial artery rather than the femoral artery, according to a Canadian study.

Several reports in recent years have demonstrated advantages of radial access for PCI, including fewer vascular complications (see Reuters Health report of October 21, 2009) and a reduction in bleeding — one of the major complications of primary PCI for STEMI.

“The aim of our study was to compare the effect of radial versus femoral access during primary PCI on the time to reperfusion, incidence of bleeding complications, and 1-year clinical outcomes after STEMI,” Dr. Serge Doucet, at the Université de Montréal, Quebec, and colleagues write in the July 15 issue of the American Journal of Cardiology.

The prospective study collected data on all patients undergoing primary PCI at the Montreal Heart Institute over a 1-year period; 234 were treated with femoral access, and 254 with radial access.

After propensity adjustment, the odds ratio for bleeding with the femoral versus radial approach was 4.22, the investigators found. Furthermore, there was no significant difference in time to revascularization between the two procedures (22.8 vs. 21.4 minutes, respectively), despite the fact that accessing the radial artery has been considered more difficult technically.

“Moreover,” Dr. Doucet and colleagues report, “the radial approach was associated with a significant reduction in major adverse cardiac events at 12 months,” with an odds ratio of 0.31. The researchers attribute this mainly to lower bleeding rates, which were strongly associated with reduced mortality at 12 months.

Reference:

Effect on Bleeding, Time to Revascularization, and One-Year Clinical Outcomes of the Radial Approach During Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Am J Cardiol 2010;106:148 –154.