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Transradial access for PCI reduces event risk in STEMI

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Elmir Omerovic

MUNICH — Patients with STEMI who underwent primary PCI via transradial access had reduced risk for 30-day mortality, cardiogenic shock and in-hospital bleeding, according to data presented at the European Society of Cardiology Congress.

Elmir Omerovic, MD, PhD, interventional cardiologist at Sahlgrenska University Hospital in Gothenburg, Sweden, and professor at University of Gothenburg, and colleagues analyzed data from 44,125 patients with STEMI from the SCAAR registry who underwent primary PCI between 2005 and 2016. Patients in this observational study either underwent PCI via transradial access (n = 24,119) or transfemoral access (n = 20,006).

The primary endpoint was 30-day mortality, and the secondary endpoints were defined as stroke, in-hospital bleeding and cardiogenic shock.

Patients who underwent primary PCI via transradial access had fewer traditional risk factors compared with those who underwent the procedure via transfemoral access.

At 30 days, death occurred in 5.2% of the overall cohort: 3.7% in the transradial group and 7.1% in the transfemoral group.

Compared with patients who underwent PCI via transfemoral access, those who underwent the procedure via transradial access had lower risk for in-hospital bleeding (OR = 0.46; 95% CI, 0.39-0.54), death (OR = 0.5; 95% CI, 0.45-0.57) and cardiogenic shock (OR = 0.5; 95% CI, 0.42-0.59) after adjustment.

The 30-day mortality and bleeding results did not vary by age, sex or cardiogenic shock. The risk for stroke was not affected by access site.

Risk estimates for 30-day mortality and cardiogenic shock were similar in instrumental variable analyses. The estimated risk for death at 30 days did not substantially change when patients with cardiogenic shock were excluded.

“Our study supports current ESC guidelines, which recommend [transradial access] as the first choice for primary PCI,” Omerovic and colleagues wrote. – by Darlene Dobkowski

Reference:

Omerovic E, et al. Abstract P5601. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.

Disclosure: Omerovic reports he has received grants from Abbott and AstraZeneca and personal fees from AstraZeneca.