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Heart, Lung and Circulation

Predictors of Radial to Femoral Artery Access Crossover During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Published:March 15, 2022DOI:https://doi.org/10.1016/j.hlc.2022.01.016

      Background

      Radial access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding, when compared to femoral access. However, radial access failure may be associated with an increased door-to-device (DTD) time.

      Aims

      To identify predictors of radial access failure requiring crossover to femoral artery access during primary PCI.

      Methods

      From 2013 to 2020, 2,256 consecutive patients treated for PPCI at a single tertiary hospital were prospectively recruited into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariable logistic regression was used to identify independent predictors of radial to femoral access crossover.

      Results

      From 2,256 STEMI patients, primary radial access was used in 1,778 (78.8%), with 171 (9.6%) experiencing radial-to-femoral crossover. Patients with failed versus successful radial access experienced longer DTD times (67 mins, interquartile range [IQR] 46–99 vs 54 mins [IQR 39-78]; p<0.001). Independent predictors of radial-to-femoral access crossover included female sex (Adjusted Odds Ratio [AOR] 2.1, 95% Confidence Interval [CI] 1.4–3.0; p<0.001) and baseline hypertension (AOR 1.5, 95% CI 1.1–2.1; p=0.018).

      Conclusion

      In a real-world STEMI registry, almost 1 in 10 patients experienced access crossover from the radial to femoral artery which resulted in longer DTD times. Independent predictors of radial access failure included female sex and baseline hypertension. Knowing which patient characteristics are associated with increased risk of radial artery failure enables catheter laboratory staff to ensure equipment is readily available to maximise successful primary PCI are available.

      Keywords

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      Reference

        • Jolly S.S.
        • Yusuf S.
        • Cairns J.
        • Niemelä K.
        • Xavier D.
        • Widimsky P.
        • et al.
        Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.
        Lancet. 2011; 377: 1409-1420
        • Campos I.
        • Galvao Braga C.
        • Costa J.
        • Quina Rodrigues C.
        • Costa Oliveira C.
        • Medeiros P.
        • et al.
        Overcoming anatomic challenges to transradial access in STEMI patients.
        Eur Heart J. 2019; 40: 4118
        • Gragnano F.
        • Branca M.
        • Frigoli E.
        • Leonardi S.
        • Vranckx P.
        • Di Maio D.
        • et al.
        Access-site crossover in patients with acute coronary syndrome undergoing invasive management.
        JACC Cardiovasc Interv. 2021; 14: 361-373
        • Zafirovska B.
        • Antov S.
        • Kostov J.
        • Spiroski I.
        • Vasilev I.
        • Jovkovski A.
        • et al.
        Benefit of routine preprocedural radial artery angiography in STEMI patients.
        Catheter Cardiovasc Interv. 2019; 93: 25-31
        • 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; 11e000035
        • Batra M.K.
        • Rai L.
        • Khan N.U.
        • Mengal M.N.
        • Khowaja S.
        • Hassan Rizvi S.N.
        • et al.
        Radial or femoral access in primary percutaneous coronary intervention (PCI): Does the choice matters?.
        Indian Heart J. 2020; 72: 166-171
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • 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.
        J Am Coll Cardiol. 2012; 60: 1581-1598
        • 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: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
        • VCOR
        Victorian Cardiac Outcomes Registry.
        Monash University, 2021
        https://vcor.org.au/
        Date accessed: July 16, 2021
        • Mehran R.
        • Rao S.V.
        • Bhatt D.L.
        • Gibson C.M.
        • Caixeta A.
        • Eikelboom J.
        • et al.
        Standardized bleeding definitions for cardiovascular clinical trials.
        Circulation. 2011; 123: 2736-2747
        • Pandie S.
        • Mehta S.R.
        • Cantor W.J.
        • Cheema A.N.
        • Gao P.
        • Madan M.
        • et al.
        Radial versus femoral access for coronary angiography/intervention in women with acute coronary syndromes: Insights from the RIVAL trial (radial vs femoral access for coronary intervention).
        JACC Cardiovasc Interv. 2015; 8: 505-512
        • Han H.C.
        twisted blood vessels: symptoms, etiology and biomechanical mechanisms.
        J Vasc Res. 2012; 49: 185-197
        • Dang D.
        • Dowling C.
        • Zaman S.
        • Cameron J.
        • Kuhn L.
        Predictors of radial to femoral artery crossover during primary percutaneous coronary intervention: a systematic review and meta-analysis.
        Heart Lung Circ. 2021; 30: S318
      1. MonashHeart, Monash Health, Interventional Services.
        • Aldoori J.S.
        • Mohammed A.I.
        Transradial approach for coronary angiography and percutaneos coronary intervention: personal experience.
        Egypt Heart J. 2019; 71: 10
        • Gu W.J.
        • Wu X.D.
        • Wang F.
        • Ma Z.L.
        • Gu X.P.
        Ultrasound guidance facilitates radial artery catheterization: a meta-analysis with trial sequential analysis of randomized controlled trials.
        Chest. 2016; 149: 166-179
        • Guedeney P.
        • Thiele H.
        • Kerneis M.
        • Barthélémy O.
        • Baumann S.
        • Sandri M.
        • et al.
        Radial versus femoral artery access for percutaneous coronary artery intervention in patients with acute myocardial infarction and multivessel disease complicated by cardiogenic shock: subanalysis from the CULPRIT-SHOCK trial.
        Am Heart J. 2020; 225: 60-68
        • Cai G.
        • Huang H.
        • Li F.
        • Shi G.
        • Yu X.
        • Yu L.
        Distal transradial access: a review of the feasibility and safety in cardiovascular angiography and intervention.
        BMC Cardiovasc Disord. 2020; 20: 356
        • Patel T.
        • Shah S.
        • Pancholy S.
        • Rao S.
        • Bertrand O.F.
        • Kwan T.
        Balloon-assisted tracking: a must-know technique to overcome difficult anatomy during transradial approach.
        Catheter Cardiovasc Interv. 2014; 83: 211-220
        • Kiemeneij F.
        • Yoshimachi F.
        • Matsukage T.
        • Amoroso G.
        • Fraser D.
        • Claessen B.E.
        • et al.
        Focus on maximal miniaturisation of transradial coronary access materials and techniques by the Slender Club Japan and Europe: an overview and classification.
        EuroIntervention. 2015; 10: 1178-1186
        • Valgimigli M.
        • Bueno H.
        • Byrne R.A.
        • Collet J.-P.
        • Costa F.
        • Jeppsson A.
        • et al.
        2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2018; 39: 213-260
        • Layne K.
        • Ferro A.
        Antiplatelet therapy in acute coronary syndrome.
        Eur Cardiol. 2017; 12: 33-37
        • Valgimigli M.
        • Frigoli E.
        • Leonardi S.
        • Vranckx P.
        • Rothenbühler M.
        • Tebaldi M.
        • et al.
        Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial.
        Lancet. 2018; 392: 835-848
        • Stehli J.
        • Martin C.
        • Brennan A.
        • Dinh D.T.
        • Lefkovits J.
        • Zaman S.
        Sex differences persist in time to presentation, revascularization, and mortality in myocardial infarction treated with percutaneous coronary intervention.
        J Am Heart Assoc. 2019; 8 (e012161-e)
        • Hay M.
        • Stehli J.
        • Martin C.
        • Brennan A.
        • Dinh D.T.
        • Lefkovits J.
        • et al.
        Sex differences in optimal medical therapy following myocardial infarction according to left ventricular ejection fraction.
        Eur J Prev Cardiol. 2020; 27: 2348-2350
        • Stehli J.
        • Dinh D.
        • Dagan M.
        • Duffy S.J.
        • Brennan A.
        • Smith K.
        • et al.
        Sex differences in prehospital delays in patients with st-segment–elevation myocardial infarction undergoing percutaneous coronary intervention.
        J Am Heart Assoc. 2021; 10e019938
        • Stehli J.
        • Duffy S.J.
        • Koh Y.
        • Martin C.
        • Brennan A.
        • Dinh D.T.
        • et al.
        Sex differences in radial access for percutaneous coronary intervention in acute coronary syndrome are independent of body size.
        Heart Lung Circ. 2020;
        • Stehli J.
        • Duffy S.J.
        • Burgess S.
        • Kuhn L.
        • Gulati M.
        • Chow C.
        • et al.
        Sex disparities in myocardial infarction: biology or bias?.
        Heart Lung Circ. 2021; 30: 18-26

      Linked Article

      • Radial First in Primary Percutaneous Coronary Intervention—Ensuring At-Risk Groups Aren’t Left Behind
        Heart, Lung and CirculationVol. 31Issue 8
        • Preview
          A decade ago, radial artery access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) represented less than 10% of procedures undertaken worldwide [1], with transfemoral access the most common route of procedural access. The landmark Radial Vs femorAL access for coronary angiography and intervention in acute coronary syndrome (ACS) patients (RIVAL) study, published in 2011, was instrumental in changing this paradigm of care. RIVAL demonstrated that radial access was associated with a significantly lower rate of vascular complications as compared to femoral access [2], a finding that has been subsequently confirmed in more recent studies demonstrating less bleeding and reduced mortality [3,4].
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