Radial access versus femoral access in myocardial infarction – a single-center experience

Abstract

Background Data on the relationship between radial access (RA) and outcome in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) are inconclusive. The aim of our study was to assess whether RA is associated with 30-day mortality in patients with MI undergoing percutaneous coronary intervention in our center or whether the possible benefit of RA is the result of less bleeding and other confounding factors. Methods We retrospectively studied 3501 consecutive patients with MI who underwent PCI between January 2012 and December 2016. The 30-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics. Results RA patients had a significantly lower 30-day unadjusted mortality [53(3.8%) patients died in the RA group compared to 207(9.8%) patients in the FA group; p<0.0001]. After adjustments for confounders, the difference was no longer significant (adjusted OR: 0.84; 95% CI: 0.58 to 1.22). Cardiogenic shock, age over 70 years, hypertension, hyperlipidemia, anemia on admission, renal dysfunction on admission, ST-elevation MI, bleeding, the contrast volume/GFR ratio, but not RA, predicted 30-day mortality. Conclusion RA was not associated with 30-day mortality in patients with MI undergoing PCI. Our study result suggests that the better outcome in the RA group was influenced by confounding factors, especially bleeding and hemodynamic impairment.

Keywords

• myocardial infarction
• percutaneous coronary intervention
• radial access