4 YEARS EXPERIENCE WITH TRANSRADIAL CORONARY ANGIOPLASTY IN ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Background: This study was performed to compare the outcome and complication rate between transradial (TR) and transfemoral (TF) PCI in STEMI.
Methods: The clinical and angiographic data of patients with STEMI treated by PCI between   January 2001 and December 2005 were reviewed and evaluated. Access site cross over, rate of access site complications, major adverse cardiac events (MACE) at 1-month and consumption of angioplasty equipment were evaluated. Patients with rescue PCI and cardiogenic shock were excluded. Results: From TR group 156 interventions were performed from right radial (93%) and 11 (6.5%) procedures from the left radial artery. The indication of left radial access was small radial artery in 7 patients (63%) and negative Allen test in 4 pts. (36%). From the TF group 43 pts. (7.3%) were excluded due to cardiogenic shock and rescue PCI. The TF interventions were performed in 357 (96%) pts. from right femoral and in 15 (n=15, 4%) pts. from left femoral artery. In the TR group the cross over rate to femoral approach was 8 (n=8, 5.1%). In TF group the procedure was accomplished via radial artery in 3 pts. (n=3, 0.8%) due to severe iliac artery tortuosity (p<0.05). The procedure was angiographically successful in all pts. in TR group (100%) and in 370 (99.4%) pts. in TF group (ns.). Major access site complications occurred in 19 pts. (5.1 %) in the TF group and none in the TR group (p<0.05). Minor entry site complications were detected in 35 pts. in TF group (9.4%), and in 6 pts. in TR group (3.5%) (p<0.05). The MACE rate was 7 in TR group (4.4%) and 41 (11%) in TF group. (p<0.05)
Conclusions: Our results suggest that TR approach is a safe and effective way for the treatment of STEMI. The lack of site related complication in the TR group is extremely important in the STEMI patient subset with high risk of bleeding risk.