Randomized Comparison of Radial Versus Femoral Approach for Patients With STEMI Undergoing Early PCI Following Intravenous Thrombolysis

Volume 24 - Issue 8 - August 2012
Posted on: 7/30/12
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Author(s):

Yan-bo Wang, MD, Xiang-hua Fu, MD, PhD, Xue-chao Wang, MD, Xin-shun Gu, MD, Yun-jun Zhao, MD, Guo-zhen Hao, MD, Yun-fa Jiang, MD, Shi-qiang Li, MD, Wei-li Wu, MD, Wei-ze Fan, MD

Abstract: Background. Early percutaneous coronary intervention (PCI) following thrombolysis may be beneficial in patients with ST-segment elevation myocardial infarction (STEMI) who were admitted at a non-PCI hospital. The aim of this study was to evaluate the safety and efficacy of the radial artery as a vascular route for early PCI following thrombolysis in patients with STEMI. Methods. All consecutive STEMI patients within 12 hours after thrombolysis were enrolled, and eligible patients were randomly assigned to either transfemoral (TFI group) or transradial catheterization (TRI group). Several time intervals were measured. The puncture success rate and ambulation time were assessed. The vascular access-site complications were also assessed after the PCI procedure, and the incidence of major adverse cardiac events (MACE) in hospital was observed. Results. A total of 119 cases were enrolled, with 60 in the TRI group and 59 in the TFI group. There were no significant differences in transfer time and total procedure time. The puncture time in the TRI group was not significantly different compared to the TFI group. The time between PCI and ambulation in the TRI group was shorter than in the TFI group. There was a trend toward lower in the incidence of bleeding complications and vascular complications in the TRI group. Conclusion. TRI for STEMI patients following intravenous thrombolysis was as safe and feasible as TFI, with a trend toward lower incidence of bleeding complications and vascular complications.

J INVASIVE CARDIOL 2012;24(8):412-416

Key words: ST-segment elevation myocardial infarction, percutaneous coronary intervention, radial artery approach, thrombolysis, major adverse cardiac event

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In the setting of ST-segment elevation myocardial infarction (STEMI), the rapid recovery of TIMI 3 flow of infarct-related artery (IRA) is one of the most important prognostic factors.¹ Up to now, primary percutaneous coronary intervention (PCI) has been accepted as the optimal strategy to recanalize IRA in STEMI.² However, as the efficacy of primary PCI is time-dependent, logistical barriers limit its use to no more than 20% of STEMI patients worldwide.^3-5 As a result, early PCI following thrombolysis may be beneficial in STEMI patients who were admitted at a non-PCI hospital.

Under these conditions of aggressive anti-coagulation and anti-platelet treatments, bleeding complications during PCI could result in increased mortality after PCI procedure.^6-8 There is an increasing amount of data suggesting that transradial PCI (TRI) could reduce bleeding complications and improve long-term outcomes when compared with procedures carried out via transfemoral artery approach (TFI).^9,10

However, published studies of TRI for STEMI have been mostly retrospective, non-randomized observations limited to primary or rescue PCI.^11-14 Therefore, this study was designed to evaluate the safety and efficacy of the radial artery as a vascular route for STEMI patients undergoing early PCI following thrombolysis.