Radial versus femoral vascular access in ST-elevation myocardial infarction: Are the results of femoral operators unfairly represented in observational research?

Blake, Sarah R, Shahzad, Adeel, Aggarwal, Suneil K, Kumar, Abhishek, Khan, Adnan and Stables, Rod H ORCID: 0000-0002-9244-7015 (2019) Radial versus femoral vascular access in ST-elevation myocardial infarction: Are the results of femoral operators unfairly represented in observational research? AMERICAN HEART JOURNAL, 210. pp. 81-87.

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Abstract

<h4>Background</h4>Recent randomized controlled trials comparing femoral and radial access in primary percutaneous coronary intervention (PPCI) have shown conflicting results regarding the incidence of major adverse cardiovascular events (MACE) and major bleeding.<h4>Methods</h4>Using data from the HEAT-PPCI trial, we compared the primary efficacy (all-cause mortality, stroke, new myocardial infarction or unplanned repeat revascularization) and safety (major bleeding BARC 3-5) outcomes at 28 days, by final access site used (radial or femoral) and by default operator type. We then assessed outcomes in femoral cases performed by both operator types.<h4>Results</h4>Radial access (RA) was associated with fewer MACE (91/1472 = 6.2% vs. 36/332 = 10.8% P = .003) and major bleeding events (38/1472 = 2.6% vs 22/332 = 6.6% P = .001) when compared to femoral access (FA). When analyzing outcomes by default operator type, there was a similar incidence of MACE (111/1575 = 7% vs 16/229 = 7% P = .97) and major bleeding events (49/1575 = 3.1% vs 11/229 = 4.8% P = .18). In cases where FA was performed by default radial operators, there was a higher rate of MACE (22/122 = 18% vs 14/210 = 6.7% P = .003) and major bleeding events (11/122 = 9% vs 11/210 = 5.2% P < .001), potentially explained by a higher risk profile in these cases.<h4>Conclusion</h4>Default femoral operators achieved comparable outcomes when compared to default radial operators. The less favorable outcomes observed in FA cases may result from its selective use by radial operators in high risk cases.

Item Type:	Article
Uncontrolled Keywords:	Femoral Artery, Radial Artery, Humans, Myocardial Infarction, Recurrence, Postoperative Hemorrhage, Postoperative Complications, Heparin, Peptide Fragments, Recombinant Proteins, Antithrombins, Hirudins, Anticoagulants, Treatment Outcome, Reoperation, Incidence, Cause of Death, Pressure, Aged, Middle Aged, Stroke, Percutaneous Coronary Intervention, Surgeons, Vascular Closure Devices, ST Elevation Myocardial Infarction
Depositing User:	Symplectic Admin
Date Deposited:	13 Mar 2019 16:45
Last Modified:	19 Jan 2023 00:57
DOI:	10.1016/j.ahj.2018.12.009
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3034196