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Bernardo Cortese, MD
Cardiologia Interventistica, Fondazione IRCCS CaÃ¢â¬â¢ Granda Ospedale Maggiore Policlinico, Milano, Italy
We read with great interest the article from SL Hetherington et al. regarding the impact of trans-radial primary PCI on clinical outcome in a sing...
We read with great interest the article from SL Hetherington et al. regarding the impact of trans-radial primary PCI on clinical outcome in a single-center experience. Authors discovered lower (although not statistically significant) in-hospital mortality rates and lower major cardiac or cerebrovascular adverse events with this technique, compared to the standard trans-femoral route. Previous studies regarding this topic were small, single-centre experiences, therefore not powered enough to demonstrate a significant clinical impact of the trans-radial technique during urgent PCI. Today, this study covers a vacuum in the literature, and being us Ã¢â¬ÅradialistsÃ¢â¬ï¿½ since our very first PCI, we appreciate that.
Anyhow, despite the well-known lower hospital stay and costs, and now with the help of such clinical evidence, Authors and the community of interventional cardiologists should now investigate why this technique is still so underused in western countries. We wonder why if a single centre uncontrolled clinical trial is able to change the overall acute myocardial infarction management in the cath lab, multi-centre, multi-national, old and recent [1, and Schufele TG, in http://directnews.americanheart.org/extras/sessions2009/slides/41_pslides.pdf, accessed 29 Nov 2009] clinical evidence-based and economical evidence-based medicine should not change current practice.
The extent of the problem of Ã¢â¬Åradial resistanceÃ¢â¬ï¿½ may be easily understood given the following numbers. Until a few years ago, only 30% of European centres adopted a routine trans-radial approach for PCIs. And has been recently disclosed that in only 1.32% of overall procedures performed in the US such approach is used.
We believe that the interventional community should stop seeing at radialists as weird colleagues and start to change their mind. Now it is not time to call for a randomized trial. This is time to call for awareness.
 Hetherington SL, Adam Z, Morley R, et al. Acute coronary syndromes: Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: changing patterns of vascular access, radial versus femoral artery. Heart 2009;95:1612-1618.
 Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008 Jun 7;371(9628):1915-20.
 Lefevre T and Louvard Y. Description and management of difficult anatomy encountered during transradial intervention. In: M. Hamon and E. McFadden, Editors, Transradial approach for cardiovascular interventions, Europa Stethoscope Media, Carpiquet (2003),241-254.
 Rao SV, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008 Aug;1(4):379-86.