Advertisement

Radial versus femoral access in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: A propensity-matched analysis from real-world data of the K-ACTIVE registry

Published:September 23, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.09.001

      Highlights

      • Radial access was selected for approximately two-thirds of ST-elevation myocardial infarction patients.
      • Door-to-device time was not compromised in radial access.
      • The ischemic and bleeding events for 30 days were significantly fewer in radial access.

      Abstract

      Background

      The access site for primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) recently shifted from femoral to radial. However, few real-world data on Japanese patients exist.

      Methods

      To elucidate the clinical selection and impact of the access site in STEMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry) in 2015 to 2021. Data were analyzed in the entire population and a propensity score-matched population adjusted for confounding factors. Major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Bleeding Academic Research Consortium (BARC) type 3 or 5 was used to assess bleeding events. MACE plus BARC type 3 or 5 bleeding were considered composite events. Clinical outcomes were followed for 30 days.

      Results

      The 6802 STEMI patients included 4786 patients with radial access (70.3 %) and 2016 with femoral access (29.7 %). Femoral access tended to be selected for more severe conditions than radial access. The median door-to-device time in the radial access group was significantly shorter than the femoral access group in the entire population (75 min versus 79 min, p < 0.01). After propensity score matching (each group, n = 1208), the incidence of MACE tended to be lower in the radial access group [risk ratio (RR) 0.83, 95 % confidence interval (CI) 0.63–1.09, p = 0.17]. The incidence of BARC 3 or 5 bleeding was significantly less in the radial access group (RR 0.47, 95%CI 0.23–0.97, p = 0.04). The incidence of composite events was significantly less in the radial access group (RR 0.74, 95%CI 0.57–0.96, p = 0.02).

      Conclusion

      In STEMI patients undergoing primary PCI, in comparison to femoral access, radial access reduced composite events in the entire population and the matched population, through a reduction in MACE and BARC 3 or 5 bleeding.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kiemeneij F.
        • Jan Laarman G.
        Percutaneous transradial artery approach for coronary stent implantation.
        Cathet Cardiovasc Diagn. 1993; 30: 173-178https://doi.org/10.1002/CCD.1810300220
        • Ochiai M.
        • Isshiki T.
        • Toyoizumi H.
        • Eto K.
        • Yokoyama N.
        • Koyama Y.
        • et al.
        Efficacy of transradial primary stenting in patients with acute myocardial infarction.
        Am J Cardiol. 1999; 83: 966-968https://doi.org/10.1016/S0002-9149(98)01050-9
        • Saito S.
        • Tanaka S.
        • Hiroe Y.
        • Miyashita Y.
        • Takahashi S.
        • Tanaka K.
        • et al.
        Comparative study on transradial approach vs. Transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the Test for Myocardial infarction by Prospective Unicenter Randomization for Access sites (TEMPURA).
        Catheter Cardiovasc Interv. 2003; 59: 26-33https://doi.org/10.1002/ccd.10493
        • Yamashita Y.
        • Shiomi H.
        • Morimoto T.
        • Yaku H.
        • Kaji S.
        • Furukawa Y.
        • et al.
        Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry.
        Heart Vessels. 2017; 32: 1448-1457https://doi.org/10.1007/s00380-017-1021-4
        • Valgimigli M.
        • Gagnor A.
        • Calabró P.
        • Frigoli E.
        • Leonardi S.
        • Zaro T.
        • et al.
        Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
        Lancet. 2015; 385: 2465-2476https://doi.org/10.1016/S0140-6736(15)60292-6
        • Kimura K.
        • Kimura T.
        • Ishihara M.
        • Nakagawa Y.
        • Nakao K.
        • Miyauchi K.
        • et al.
        JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome.
        Circ J. 2019; 83: 1085-1196https://doi.org/10.1253/circj.CJ-19-0133
        • Ozaki Y.
        • Katagiri Y.
        • Onuma Y.
        • Amano T.
        • Muramatsu T.
        • Kozuma K.
        • et al.
        CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018.
        Cardiovasc Interv Ther. 2018; 33: 178-203https://doi.org/10.1007/S12928-018-0516-Y
        • Ibanez B.
        • James S.
        • Agewall S.
        • Antunes M.J.
        • Bucciarelli-Ducci C.
        • Bueno H.
        • et al.
        2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.
        Eur Heart J. 2018; 39: 119-177https://doi.org/10.1093/eurheartj/ehx393
        • Mason P.J.
        • Shah B.
        • Tamis-Holland J.E.
        • Bittl J.A.
        • Cohen M.G.
        • Safirstein J.
        • et al.
        An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association.
        Circ Cardiovasc Interv. 2018; 11e000035https://doi.org/10.1161/HCV.0000000000000035
        • Ozaki Y.
        • Hara H.
        • Onuma Y.
        • Katagiri Y.
        • Amano T.
        • Kobayashi Y.
        • et al.
        CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022.
        Cardiovasc Interv Ther. 2022; 37: 1-34https://doi.org/10.1007/S12928-021-00829-9
        • Inohara T.
        • Kohsaka S.
        • Yamaji K.
        • Amano T.
        • Fujii K.
        • Oda H.
        • et al.
        Impact of institutional and operator volume on short-term outcomes of percutaneous coronary intervention: a report from the Japanese Nationwide Registry.
        JACC Cardiovasc Interv. 2017; 10: 918-927https://doi.org/10.1016/J.JCIN.2017.02.015
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • et al.
        Third universal definition of myocardial infarction.
        Eur Heart J. 2012; 33: 2551-2567https://doi.org/10.1093/eurheartj/ehs184
        • Mehran R.
        • Rao S.V.
        • Bhatt D.L.
        • Gibson C.M.
        • Caixeta A.
        • Eikelboom J.
        • et al.
        Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium.
        Circulation. 2011; 123: 2736-2747https://doi.org/10.1161/CIRCULATIONAHA.110.009449
        • Siudak Z.
        • Tokarek T.
        • Dziewierz A.
        • Wysocki T.
        • Wiktorowicz A.
        • Legutko J.
        • et al.
        Reduced periprocedural mortality and bleeding rates of radial approach in ST-segment elevation myocardial infarction. Propensity score analysis of data from the ORPKI Polish National Registry.
        EuroIntervention. 2017; 13: 843-850https://doi.org/10.4244/EIJ-D-17-00078
        • Dworeck C.
        • Redfors B.
        • Völz S.
        • Haraldsson I.
        • Angerås O.
        • Råmunddal T.
        • et al.
        Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry.
        Eur Heart J Acute Cardiovasc Care. 2020; 9: 323-332https://doi.org/10.1177/2048872620908032
        • Mughal L.H.
        • Sastry S.
        Advances in the treatment of ST elevation myocardial infarction in the UK.
        JRSM Cardiovasc Dis. 2022; 11204800402210755https://doi.org/10.1177/20480040221075519
        • Reifart J.
        • Göhring S.
        • Albrecht A.
        • Haerer W.
        • Levenson B.
        • Ringwald G.
        • et al.
        Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK).
        BMC Cardiovasc Disord. 2022; 22: 7https://doi.org/10.1186/S12872-021-02283-0
        • Natsuaki M.
        • Morimoto T.
        • Yamaji K.
        • Watanabe H.
        • Yoshikawa Y.
        • Shiomi H.
        • et al.
        Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores.
        J Am Heart Assoc. 2018; 7e008708https://doi.org/10.1161/JAHA.118.008708
        • Chodór P.
        • Krupa H.
        • Kurek T.
        • Sokal A.
        • Swierad M.
        • Was T.
        • et al.
        RADIal versus femoral approach for percutaneous coronary interventions in patients with acute myocardial infarction (RADIAMI): a prospective, randomized, single-center clinical trial.
        Cardiol J. 2009; 16: 332-340
        • Mohandes M.
        • Rojas S.
        • Guarinos J.
        • Fernández F.
        • Moreno C.
        • Torres M.
        • et al.
        Procedure time comparison between radial versus femoral access in ST-segment elevation acute myocardial infarction patients undergoing emergent percutaneous coronary intervention: a meta-analysis of controlled randomized trials.
        Heart Views. 2018; 19: 1https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_82_16
        • Huded C.P.
        • Kapadia S.R.
        • Ballout J.A.
        • Krishnaswamy A.
        • Ellis S.G.
        • Raymond R.
        • et al.
        Association of adoption of transradial access for percutaneous coronary intervention in ST elevation myocardial infarction with door-to-balloon time.
        Catheter Cardiovasc Interv. 2020; 96: E165-E173https://doi.org/10.1002/CCD.28785
        • Nathan A.S.
        • Raman S.
        • Yang N.
        • Painter I.
        • Khatana S.A.M.
        • Dayoub E.J.
        • et al.
        Association between 90-minute door-to-balloon time, selective exclusion of myocardial infarction cases, and access site choice.
        Circ Cardiovasc Interv. 2020; 13e009179https://doi.org/10.1161/CIRCINTERVENTIONS.120.009179
        • Eikelboom J.W.
        • Mehta S.R.
        • Anand S.S.
        • Xie C.
        • Fox K.A.A.
        • Yusuf S.
        Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.
        Circulation. 2006; 114: 774-782https://doi.org/10.1161/CIRCULATIONAHA.106.612812
        • Manoukian S.V.
        • Feit F.
        • Mehran R.
        • Voeltz M.D.
        • Ebrahimi R.
        • Hamon M.
        • et al.
        Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes.
        J Am Coll Cardiol. 2007; 49: 1362-1368https://doi.org/10.1016/j.jacc.2007.02.027
        • Urban P.
        • Mehran R.
        • Colleran R.
        • Angiolillo D.J.
        • Byrne R.A.
        • Capodanno D.
        • et al.
        Defining high bleeding risk in patients undergoing percutaneous coronary intervention.
        Circulation. 2019; 140: 240-261https://doi.org/10.1161/CIRCULATIONAHA.119.040167
        • Natsuaki M.
        • Morimoto T.
        • Shiomi H.
        • Ehara N.
        • Taniguchi R.
        • Tamura T.
        • et al.
        Application of the modified high bleeding risk criteria for Japanese patients in an all-comers registry of percutaneous coronary intervention - from the CREDO-Kyoto Registry Cohort-3 -.
        Circ J. 2021; 85: 769-781https://doi.org/10.1253/circj.CJ-20-0836
        • Watanabe H.
        • Morimoto T.
        • Natsuaki M.
        • Yamamoto K.
        • Obayashi Y.
        • Ogita M.
        • et al.
        Comparison of clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy with 12 months of dual antiplatelet therapy in patients with acute coronary syndrome: the STOPDAPT-2 ACS Randomized Clinical Trial.
        JAMA Cardiol. 2022; 7: 407-417https://doi.org/10.1001/JAMACARDIO.2021.5244
        • Valgimigli M.
        • Frigoli E.
        • Heg D.
        • Tijssen J.
        • Jüni P.
        • Vranckx P.
        • et al.
        Dual antiplatelet therapy after PCI in patients at high bleeding risk.
        N Engl J Med. 2021; 385: 1643-1655https://doi.org/10.1056/NEJMOA2108749
        • Di Santo P.
        • Simard T.
        • Wells G.A.
        • Jung R.G.
        • Ramirez F.D.
        • Boland P.
        • et al.
        Transradial versus transfemoral access for percutaneous coronary intervention in ST-segment-elevation myocardial infarction: a systematic review and meta-analysis.
        Circ Cardiovasc Interv. 2021; 14: 261-269https://doi.org/10.1161/CIRCINTERVENTIONS.120.009994