Author + information
- Received March 27, 2013
- Revision received October 4, 2013
- Accepted October 7, 2013
- Published online March 1, 2014.
- Edward L. Hannan, PhD∗∗ (, )
- Louise Szypulski Farrell, MS∗,
- Gary Walford, MD†,
- Peter B. Berger, MD‡,
- Nicholas J. Stamato, MD§,
- Ferdinand J. Venditti, MD‖,
- Alice K. Jacobs, MD¶,
- David R. Holmes Jr., MD#,
- Samin Sharma, MD∗∗ and
- Spencer B. King III, MD††
- ∗University at Albany, State University of New York, Albany, New York
- †Johns Hopkins University, Baltimore, Maryland
- ‡Geisinger Medical Center, Danville, Pennsylvania
- §United Health Services, Binghamton, New York
- ‖Albany Medical Center, Albany, New York
- ¶Boston Medical Center, Boston, Massachusetts
- #Mayo Clinic, Rochester, Minnesota
- ∗∗Mount Sinai Hospital, New York, New York
- ††St. Joseph's Health System, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. Edward L. Hannan, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456.
Objectives This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in common practice.
Background Radial access for PCI has been studied considerably, but mostly in clinical trials.
Methods All patients undergoing PCI for STEMI in 2009 to 2010 in New York were studied to determine the frequency and the patient-level predictors of radial access. Differences in in-hospital/30-day mortality between radial and femoral access were also studied.
Results Radial access increased from 4.9% in the first quarter of 2009 to 11.9% in the last quarter of 2010. Significant independent predictors were higher body surface area, non-Hispanic ethnicity, Caucasian race, stable hemodynamic state, ejection fraction <30% and ≥50% onset of STEMI from 12 to 23 h before the index procedure, and peripheral vascular disease. Mortality was not related to access site after adjustment for covariates (for radial vs. femoral access, adjusted odds ratio: 0.86, 95% confidence interval: 0.59 to 1.25), but the radial access site was trending toward lower mortality for the 9 hospitals that used it for more than 10% of their patients (adjusted odds ratio: 0.61, 95% confidence interval: 0.36 to 1.02).
Conclusions The use of a radial access site for PCI in STEMI patients increased between 2009 and 2010, but was still infrequent in 2010, and was used for lower-risk STEMI patients. There was no significant difference in mortality by access site, but there was a trend toward a mortality advantage for patients with a radial access site among hospitals that used it relatively frequently.
This study was funded in part by the New York State Department of Health. Dr. Berger has received consultant fees from Medicure and Janssen Pharmaceuticals; and funding as an investigator for the Geisinger Clinic from AstraZeneca, The Medicines Company, Bristol-Myers Squibb, sanofi-aventis, and Eli Lilly and Company/Daiichi Sankyo. Dr. Jacobs is Site PI on the Xience V Everolimus Eluting Coronary Stent System (EECSS) USA Post-Approval Study. Dr. Sharma is on the Speaker's Bureau of Boston Scientific, Abbott Vascular, Angioscore, Eli Lilly and Company/Daiichi Sankyo, and The Medicines Company. Dr. King has received consulting fees from Merck & Company, Wyeth Pharmaceuticals, nContact Surgical, Medtronic, and Celonova Biosciences; and is the editor-in-chief of JACC: Cardiovascular Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 27, 2013.
- Revision received October 4, 2013.
- Accepted October 7, 2013.
- American College of Cardiology Foundation