Radial versus Femoral Approach for STEMI Patients Undergoing Primary or Rescue PCI: Alexandria University Experience

Abstract Background: Radial access for primary or rescue percu-taneous coronary intervention (PCI) became the standard of care approach in most of the PCI capable centers and it is currently recommended by most recent guidelines as the vascular access of choice for performing such interventions being more convenient for the patient and associated with less bleeding complications and shorter hospital stay. Aim of Study: To compare both transradial and transfemoral approaches in primary percutaneous coronary intervention (PCI) and rescue PCI for STEMI in two Primary PCI capable centers in Alexandria, Egypt. Patients and Methods: This prospective observational study was done at Alexandria University Hospital and Inter-national Cardiac Center in the period between January 2020 and August 2020 by recruiting every patient who had met the study inclusion criteria (STEMI according to the third universal definition of MI) and admitted to the coronary care unit after undergoing primary or rescue PCI. 200 patients were included. The patients were divided into two equal groups randomly assigned to either radial access approach or femoral access approach for primary or rescue PCI. Chest pain to time of first medical contact (FMC), and the procedural time were calculated. Coronary angiography and PCI procedure were described including materials used and the procedure compli-cations. MACE (Major Adverse Cardiac Events) or other hemodynamic complications were documented. All the patients were followed-up for 6 months after the procedure by inter-viewing with the patients via telephone or through the respon-sible physician to determine the outcomes procedure. Results: The 2 groups were well matched concerning the demographic variables and risk factors. There had been significant differences between the groups concerning the primary end point (MACE) after 6 months in favor of radial group patients with p-value (0.004). Furthermore, there was significant difference between the two studied groups con-cerning the total bleeding complication with higher risk in femoral group (11%) compared to radial group (3%), p-value (0.02).
The total procedural time was significantly longer in radial group compared to femoral group with (p-value 0.037). However, the rate of non-culprit vessel revascularization was significantly higher in radial group 17% compared to 6% in femoral group with p-value of (0.015). In-hospital stay was significantly shorter in the radial group patients. Conclusion: Transradial approach is safe, and effective with a high procedural success rate as the transfemoral ap-proach but with lower risk for bleeding. Transradial approach has additional advantages in decreasing the incidence of MACE and shortening the hospital stay compared to trans-femoral approach.