Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry

Author:

Dworeck Christian1,Redfors Björn1,Völz Sebastian1,Haraldsson Inger1,Angerås Oskar1,Råmunddal Truls1,Ioanes Dan1,Myredal Anna1,Odenstedt Jacob1,Hirlekar Geir1,Koul Sasha2,Fröbert Ole3,Linder Rickard4,Venetsanos Dimitrios4,Hofmann Robin5,Ulvenstam Anders6,Petursson Petur1,Sarno Giovanna7,James Stefan7,Erlinge David2,Omerovic Elmir1

Affiliation:

1. Department of Cardiology, Sahlgrenska University Hospital, Sweden

2. Department of Cardiology, Clinical Sciences, Lund University, Sweden

3. Department of Cardiology, Örebro University, Sweden

4. Department of Cardiology, Karolinska University Hospital, Sweden

5. Department of Clinical Science and Education, Karolinska Institutet, Sweden

6. Department of Cardiology, Östersund Hospital, Sweden

7. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden

Abstract

Objectives The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. Results During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55–0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25–0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24–0.73, P = 0.002). Conclusions In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

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