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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Article info
Publication history
Published online: March 15, 2022
Accepted:
January 26,
2022
Received in revised form:
January 17,
2022
Received:
November 7,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Radial First in Primary Percutaneous Coronary Intervention—Ensuring At-Risk Groups Aren’t Left BehindHeart, Lung and CirculationVol. 31Issue 8
- PreviewA 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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