Author + information
- Received July 20, 2011
- Accepted August 4, 2011
- Published online January 1, 2012.
- Marco Valgimigli, MD, PhD⁎,†,⁎ (, )
- Francesco Saia, MD, PhD‡,
- Paolo Guastaroba, MSc§,
- Alberto Menozzi, MD¶,
- Paolo Magnavacchi, MD#,
- Andrea Santarelli, MD‡‡,
- Francesco Passerini, MD§§,
- Pietro Sangiorgio, MD∥,
- Antonio Manari, MD∥∥,
- Fabio Tarantino, MD¶¶,
- Massimo Margheri, MD##,
- Alberto Benassi, MD⁎⁎,
- Massimo Giuseppe Sangiorgi, PhD††,
- Stefano Tondi, MD#,
- Antonio Marzocchi, MD‡,
- REAL Registry Investigators
- ↵⁎Reprint requests and correspondence:
Dr. Marco Valgimigli, University of Ferrara, Cardiovascular Institute, Arcispedale S. Anna Hospital, Corso Giovecca 203, 44100 Ferrara, Italy
Objectives This study sought to assess whether transradial intervention, by minimizing access-site bleeding and vascular events, improves outcomes in patients with ST-segment elevation myocardial infarction compared with the transfemoral approach.
Background Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty.
Methods We identified all adults undergoing percutaneous intervention for acute myocardial infarction in Emilia-Romagna, a region in the north of Italy of 4 million residents, between January 1, 2003, and July 30, 2009, at 12 referral hospitals using a region-mandated database of percutaneous coronary intervention procedures. Differences in the risk of death at 2 years between patients undergoing transfemoral versus transradial intervention, assessed on an intention-to-treat basis, were determined from vital statistics records and compared based on propensity score adjustment and matching.
Results A total of 11,068 patients were treated for acute myocardial infarction (8,000 via transfemoral and 3,068 via transradial route). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for the transradial than for the transfemoral group (8.8% vs. 11.4%; p = 0.0250). The rate of vascular complications requiring surgery or need for blood transfusion were also significantly decreased in the transradial group (1.1% vs. 2.5%, p = 0.0052).
Conclusions In patients undergoing angioplasty for acute myocardial infarction, transradial treatment is associated with decreased 2-year mortality rates and a reduction in the need for vascular surgery and/or blood transfusion compared with transfemoral intervention.
- primary angioplasty
- propensity-score matching
- ST-segment elevation myocardial infarction
- transradial intervention
This study did not receive any external funding. Dr. Valgimigli has received honoraria for lectures, served on the advisory board, and received research grants from Merck, Iroko, Eli Lilly, and Medtronic; has received honoraria for lectures and served on the advisory board for The Medicines Company and Eli Lilly Co., Daiichi Sankyo Inc., St. Jude Medical and Abbott Vascular; and has received honoraria for lectures from Cordis, CID, and Terumo. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received July 20, 2011.
- Accepted August 4, 2011.
- American College of Cardiology Foundation