All in favor of radial percutaneous coronary intervention, raise your (patient’s) hand: Editorial Comment.
Steven R. Bailey, MD, FSCAI, San Antonio, Texas.
Time to arterial access and myocardial reperfusion have been demonstrated to be critical in decreasing mortality in the setting of acute ST segment Myocardial Infarction (STEMI). An important observation from two recent meta-analyses demonstrate the impact of periprocedural bleeding on short and long term mortality in those patients with bleeding requiring transfusion. They also demonstrate a decreased rate of major bleeding when primary PCI is performed from the radial access compared to the femoral access.
The single center prospective registry in this issue of CCI from Pancholy offers us the opportunity to view the impact in a single practice of the radial versus a transfemoral strategy. The very experienced operators used the strategy they were most comfortable with and approximately twice a many procedures were performed from the transfemoral approach. In this center, the time to arterial access, door to balloon times and TIMI III flows were all similar. The anticoagulation strategy included unfractionated heparin and glycoprotein IIb/IIIa therapy in over 98% of patients. The pre discharge mortality was very low (<3%) in each arm. The primary difference was the incidence of access site complications which occurred in 9.8% of the transfemoral group compared to one in the radial access group. Those patients who suffered an access site complication were more likely to require a transfusion (16/20 patients). This small study did not demonstrate any differences in Major Cardiac Events (MACE) between the femoral and radial access groups.
For operators and laboratories with experience in transradial access, studies such as this continue to demonstrate that this is a clinically viable strategy for STEMI primary PCI. While meta-analyses suggest a benefit from the transradial access approach, small studies such as this are unlikely to help provide further elucidation. Careful investigation of the impact of reduced bleeding should be an important question for future investigations.
Catheterization and Cardiovascular Interventions 75:996 (2010).