Elsevier

American Heart Journal

Volume 150, Issue 3, September 2005, Pages 543-549
American Heart Journal

Clinical Investigation
Interventional Cardiology
Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction—the RADIAL-AMI pilot randomized trial

https://doi.org/10.1016/j.ahj.2004.10.043Get rights and content

Background

Transradial percutaneous coronary intervention (PCI) results in fewer vascular complications, earlier ambulation, and improved patient comfort. Limited data exist for radial access in acute myocardial infarction, where reperfusion must occur quickly.

Methods

In a multicenter pilot trial, 50 patients with myocardial infarction requiring either primary or rescue PCI were randomized to radial or femoral access. All operators had previously performed at least 100 transradial cases. Procedure times were prospectively recorded.

Results

Thrombolysis was used in 66% of the cases and glycoprotein IIb/IIIa inhibitors in 94%. Crossover from radial to femoral access was required in one case. Percutaneous coronary intervention was performed in 47 patients, with stenting in 45. One procedural failure occurred with radial access because of inability to cross the occlusion. The time from local anesthesia to first balloon inflation was 32 (25th percentile 26, 75th percentile 38) minutes for radial access and 26 (22, 33) minutes for femoral access (P = .04). There were no significant differences in contrast use or fluoroscopy time. No patient experienced major bleeding or required transfusion. Doppler studies demonstrated 2 asymptomatic radial occlusions and 2 pseudoaneurysms (1 from each group). One patient in the femoral group died 2 days after PCI. At 30 days, there were no strokes or reinfarctions and no patient required bypass surgery or repeat PCI.

Conclusions

Primary and rescue PCI can be performed with high success rates using either radial or femoral access. Although radial access was associated with a longer time to first balloon inflation, the difference was small and likely not clinically significant. In patients without shock, major bleeding and vascular complications are infrequent with either access site despite the high use of thrombolysis and glycoprotein IIb/IIIa inhibitors.

Section snippets

Study population

All patients with STEMI who were referred for primary or rescue PCI at participating PCI centers were screened for eligibility. For primary and rescue PCI, patients could be enrolled within 12 hours of symptom onset and within 12 hours of thrombolysis, respectively. Rescue PCI was performed for suspected failed reperfusion or reocclusion based on symptoms and electrocardiographic changes. Patients were excluded if they were in cardiogenic shock, had an abnormal Allen's test result, or had

Baseline characteristics

Thirty-three patients undergoing rescue PCI and 17 patients undergoing primary PCI were randomized to either radial (n = 25) or femoral (n = 25) arterial access. The baseline characteristics are summarized in Table I. There were more women in the radial group (24% vs 0%, P = .009). There were no other significant differences in patient demographics, risk factors, indication for PCI, or infarct location.

Procedural outcomes

Only one patient in the radial group required crossover to femoral access because of

Discussion

In this randomized pilot study, we have shown that primary and rescue PCI can be performed with high procedural success rates using either radial or femoral access. Radial access was associated with a small but statistically significant increase in the time to first balloon inflation. In this study, no major bleeding occurred with either access route despite the frequent use of thrombolysis and GP IIb/IIIa inhibitors in most cases. Nonsignificant trends of fewer hematomas and drops in

References (31)

  • G. Steg et al.

    Radial access for primary PTCA in patients with acute myocardial infarction and contraindication or impossible femoral access

    Catheter Cardiovasc Diagn

    (1996)
  • S.R. Mulukutia et al.

    Feasibility and efficacy of transradial access for coronary interventions in patients with acute myocardial infarction

    Catheter Cardiovasc Interv

    (2002)
  • D.W. Mathias et al.

    Transradial coronary angioplasty and stent implantation in acute myocardial infarction: initial experience

    J Invasive Cardiol

    (2002)
  • M.H. Kim et al.

    Primary stenting for acute myocardial infarction via transradial approach: a safe and useful alternative to the transfemoral approach

    J Invasive Cardiol

    (2000)
  • S. Kassam et al.

    Radial vs femoral access for rescue percutaneous coronary intervention with adjuvant glycoprotein IIb/IIIa inhibitor use

    Can J Cardiol

    (2004)
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