Abstract 20311: Radial versus Femoral Access in Primary Percutaneous Coronary Intervention: A Matched_Pairs Analysis in an Asian Cohort
Background: There are limited data on use of the transradial approach for primary percutaneous coronary intervention (PCI).
Methods: We compared differences in door-to-balloon time and major bleeding among matched-pairs of 274 Asian patients undergoing either the transradial or transfemoral approach as the initial access site for primary PCI at an academic medical centre, from January 2008 to April 2010. Matching was performed using a weighted Euclidean-nearest neighbor metric of 5 variables.
Results: Transradial and transfemoral cases were well-matched (table 1); in particular, anthropometric differences were minimized to limit bias in access site selection. There were 168 Chinese, 58 Malay, 39 Indian and 9 patients of other Asian ethnicity. Median door-to-balloon time was numerically but not statistically significantly greater by 3 minutes in the transradial group. Despite almost 2-fold greater use of glycoprotein inhibitors in the transradial group (78% vs. 42%, p<0.001), major bleeding was not greater than the transfemoral group. Inhospital death, MI and stroke rates were equivalent despite more anterior myocardial infarction and shock cases in the transradial group. Although there were no cases of failed transradial access or radial artery spasm, 5% of the transradial group required additional femoral access for intra-aortic balloon pump insertion. No ethnic differences were observed.
Conclusions: In this ST-elevation myocardial infarction matched case-cohort study, the transradial and trnsfemoral approaches achieved similar door-to-balloon times. The transradial approach may permit optimization of antithrombotic therapy in ST-elevation myocardial infarction. Randomized trials to better define the role of radial access in primary PCI are needed.
- © 2010 by American Heart Association, Inc.