A comparison of transradial and transfemoral approaches for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients in a high volume percutaneous coronary intervention center

Background Large percutaneous coronary intervention(PCI) centers have shown statistically better prognosis with transradial approach(TRA) compared with transfemoral approach(TFA). So we tried to compare the outcomes between TRA and TFA in one high volume PCI center in ST-segment elevation myocardial infarction(STEMI) patients undergoing primary PCI. Method Six hundred and sixty two STEMI patients who underwent primary PCI with stents implantation were retrospectively included from June 1, 2006 to April 30,2011 in our hospital and prospectively followed for one year. The primary endpoint was defined as in-hospital net adverse clinical events(NACE) which included death, myocardial infarction(MI), stroke, target vessel revascularization(TVR) and major bleeding. The secondary endpoint was defined as 1 year major adverse cardiovascular events(MACE) which included death, MI and TVR. Results The occurrence rates of NACE(8.0% vs. 17.0%, P = 0.0018), access site complications(4.0% vs. 10.7% P = 0.0027) and access site-related major bleeding(2.4% vs. 6.3%, P = 0.0254) were all higher in the TFA group than in the TRA group. The incidence rate of 1 year MACE was similar between TRA and TFA(8.5% vs. 13.2%, P = 0.0932). The inverse probabilities weighting matched multivariable Cox regression analysis showed TRA was an independent predictor of lower rates of in-hospital NACE(HR: 0.58, 95% CI: 0.34-0.99, P = 0.0477), in-hospital death(HR: 0.31, 95% CI: 0.10-0.73, P = 0.0499) and access site complications(HR: 0.37, 95% CI: 0.19-0.73,P = 0.0040). Conclusions TRA showed great efficacy and safety for STEMI patients undergoing primary PCI in high volume PCI centers. It should be recommended as routine practice in future, and especially in those patients with high risk of bleeding.