Author + information
- Received April 5, 2013
- Accepted April 11, 2013
- Published online August 1, 2013.
- Wassef Karrowni, MD∗∗ (, )
- Ankur Vyas, MD∗,
- Bria Giacomino, DO∗,
- Marin Schweizer, PhD†,
- Amy Blevins, MALS∗,
- Saket Girotra, MD, SM∗ and
- Phillip A. Horwitz, MD∗
- ∗Department of Cardiovascular Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa
- †Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- ↵∗Reprint requests and correspondence:
Dr. Wassef Karrowni, University of Iowa Hospitals and Clinics, Division of Cardiovascular Diseases, 200 Hawkins Drive, Int. Med. E316-1 GH, Iowa City, Iowa 52242.
Objectives This study sought to determine the safety and efficacy of radial access compared with femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Background Numerous randomized controlled trials, including several new studies, have compared outcomes of these approaches in the context of primary PCI for STEMI patients with inconclusive results.
Methods We performed a meta-analysis of randomized controlled trials to compare outcomes in STEMI patients undergoing radial versus femoral access for primary PCI. Primary outcomes were death and major bleeding evaluated at the longest available follow-up. Secondary outcomes included access site bleeding, stroke, and procedure time. Twelve studies (N = 5,055) were included. All trials were conducted in centers experienced with both approaches.
Results Compared with femoral approach, radial approach was associated with decreased risk of mortality (2.7% vs. 4.7%; odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.40 to 0.76; p < 0.001) and decreased risk of major bleeding (1.4% vs. 2.9%; OR: 0.51, 95% CI: 0.31 to 0.85; p = 0.01). Radial access was also associated with reduction in relative risk of access site bleeding (2.1% vs. 5.6%; OR: 0.35, 95% CI: 0.25 to 0.50; p < 0.001). Stroke risk was similar between both approaches (0.5% vs. 0.5%; OR: 1.07, 95% CI: 0.45 to 2.54; p = 0.87). The procedure time was slightly longer in the radial group than in the femoral group (mean difference: 1.52 min; 95% CI: 0.33 to 2.70, p = 0.01).
Conclusions In STEMI patients undergoing primary PCI, the radial approach is associated with favorable outcomes and should be the preferred approach for experienced radial operators.
Dr. Horwitz has received research grants from Boston Scientific and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Karrowni and Vyas contributed equally to this paper.
- Received April 5, 2013.
- Accepted April 11, 2013.
- American College of Cardiology Foundation