Christiana Schernthaner1, Matthias Hammerer1, Stefan Harb2, Matthias Heigert1, Kurt Hoellinger3, Elisabeth Lassnig4, Edwin Maurer4, Jochen Schuler1,5, Peter Siostrzonek3, Hanno Ulmer6, Andreas Winter3, Johann Altenberger7,8. 1. Department of Cardiology, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria. 2. Department of Cardiology, Landeskrankenhaus Graz West, Goestingerstrasse 22, 8020, Graz, Austria. 3. Department of Cardiology, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Austria. 4. Klinikum Kreuzschwestern Wels, Grieskirchnerstrasse 42, 4600, Wels, Austria. 5. Institute of General Practice, Family and Preventive Medicine, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria. 6. Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstrasse 41, 6020, Innsbruck, Austria. 7. Department of Cardiology, Paracelsus Medical University Salzburg, Muellner Hauptstraße 48, 5020, Salzburg, Austria. johann.altenberger@pensionsversicherung.at. 8. Cardiac Rehabilitation Center, Academic Educational Hospital, Paracelsus Medical University Salzburg, Pensionsversicherung, Salzburger Strasse 520, 5084, Großgmain, Austria. johann.altenberger@pensionsversicherung.at.
Abstract
BACKGROUND:Transradial access (TRA) in percutaneous coronary intervention (PCI) is a widely used standard technique with lower complication rates compared to transfemoral access (TFA). The aim of this study was to evaluate the impact of TRA versus TFA for PCI on clinically significant vascular access complications in the setting of acute myocardial infarction (AMI). METHODS: This multicenter study randomly assigned 250 patients in a 1:1 fashion (TRA vs. TFA) admitted with or without ST-segment elevation AMI undergoing immediate PCI. The primary endpoint was defined as the occurrence of hematoma, pseudo-aneurysm or local bleeding at the access site requiring any further intervention and/or prolonged hospital stay. Radiation exposure to the patient and operator was also investigated. RESULTS: In the study cohort (N = 250 patients, mean age 62 ± 12.7 years, 76% males) 5 patients (2%) achieved the primary endpoint without a significant difference between groups, 4 out of 125 (3.2%) in the TFAgroup and 1 out of 125 (0.8%) in the TRA group (p = 0.17). Access site hematoma was significantly more frequent in the TFA group compared to the TRA group (24.8% vs. 8.8%, respectively; p < 0.0007). Local bleeding was only seen in the TFA group (3.2% vs. 0%, p = 0.04). Time intervals from admission to catheter laboratory to first balloon inflation were longer in the TRA compared to the TFA group (34 ± 17 min vs 29.5 ± 13 min, respectively; p = 0.018). Radiation exposure to the patient and operator was identical. CONCLUSION: The use of TRA was accompanied by lower rates of access site complications; however, the need for subsequent treatment or prolonged hospital stays was not observed using either of the two access approaches.
RCT Entities:
BACKGROUND: Transradial access (TRA) in percutaneous coronary intervention (PCI) is a widely used standard technique with lower complication rates compared to transfemoral access (TFA). The aim of this study was to evaluate the impact of TRA versus TFA for PCI on clinically significant vascular access complications in the setting of acute myocardial infarction (AMI). METHODS: This multicenter study randomly assigned 250 patients in a 1:1 fashion (TRA vs. TFA) admitted with or without ST-segment elevation AMI undergoing immediate PCI. The primary endpoint was defined as the occurrence of hematoma, pseudo-aneurysm or local bleeding at the access site requiring any further intervention and/or prolonged hospital stay. Radiation exposure to the patient and operator was also investigated. RESULTS: In the study cohort (N = 250 patients, mean age 62 ± 12.7 years, 76% males) 5 patients (2%) achieved the primary endpoint without a significant difference between groups, 4 out of 125 (3.2%) in the TFA group and 1 out of 125 (0.8%) in the TRA group (p = 0.17). Access site hematoma was significantly more frequent in the TFA group compared to the TRA group (24.8% vs. 8.8%, respectively; p < 0.0007). Local bleeding was only seen in the TFA group (3.2% vs. 0%, p = 0.04). Time intervals from admission to catheter laboratory to first balloon inflation were longer in the TRA compared to the TFA group (34 ± 17 min vs 29.5 ± 13 min, respectively; p = 0.018). Radiation exposure to the patient and operator was identical. CONCLUSION: The use of TRA was accompanied by lower rates of access site complications; however, the need for subsequent treatment or prolonged hospital stays was not observed using either of the two access approaches.
Authors: Martial Hamon; Christian Pristipino; Carlo Di Mario; James Nolan; Josef Ludwig; Marco Tubaro; Manel Sabate; Josepa Mauri-Ferré; Kurt Huber; Kari Niemelä; Michael Haude; William Wijns; Dariusz Dudek; Jean Fajadet; Ferdinand Kiemeneij Journal: EuroIntervention Date: 2013-03 Impact factor: 6.534
Authors: Marco Valgimigli; Francesco Saia; Paolo Guastaroba; Alberto Menozzi; Paolo Magnavacchi; Andrea Santarelli; Francesco Passerini; Pietro Sangiorgio; Antonio Manari; Fabio Tarantino; Massimo Margheri; Alberto Benassi; Massimo Giuseppe Sangiorgi; Stefano Tondi; Antonio Marzocchi Journal: JACC Cardiovasc Interv Date: 2012-01 Impact factor: 11.195
Authors: Roxana Mehran; Stuart J Pocock; Eugenia Nikolsky; Tim Clayton; George D Dangas; Ajay J Kirtane; Helen Parise; Martin Fahy; Steven V Manoukian; Frederick Feit; Magnus E Ohman; Bernard Witzenbichler; Giulio Guagliumi; Alexandra J Lansky; Gregg W Stone Journal: J Am Coll Cardiol Date: 2010-06-08 Impact factor: 24.094
Authors: Sanjit S Jolly; Salim Yusuf; John Cairns; Kari Niemelä; Denis Xavier; Petr Widimsky; Andrzej Budaj; Matti Niemelä; Vicent Valentin; Basil S Lewis; Alvaro Avezum; Philippe Gabriel Steg; Sunil V Rao; Peggy Gao; Rizwan Afzal; Campbell D Joyner; Susan Chrolavicius; Shamir R Mehta Journal: Lancet Date: 2011-04-04 Impact factor: 79.321
Authors: Ivo Bernat; David Horak; Josef Stasek; Martin Mates; Jan Pesek; Petr Ostadal; Vlado Hrabos; Jaroslav Dusek; Jiri Koza; Zdenek Sembera; Miroslav Brtko; Ondrej Aschermann; Michal Smid; Pavel Polansky; Abdul Al Mawiri; Jan Vojacek; Josef Bis; Olivier Costerousse; Olivier F Bertrand; Richard Rokyta Journal: J Am Coll Cardiol Date: 2013-11-21 Impact factor: 24.094
Authors: Steven M Bradley; Sunil V Rao; Jeptha P Curtis; Craig S Parzynski; John C Messenger; Stacie L Daugherty; John S Rumsfeld; Hitinder S Gurm Journal: Circ Cardiovasc Qual Outcomes Date: 2014-06-04
Authors: Karim Ratib; Mamas A Mamas; Simon G Anderson; Gurbir Bhatia; Helen Routledge; Mark De Belder; Peter F Ludman; Douglas Fraser; James Nolan Journal: JACC Cardiovasc Interv Date: 2015-01 Impact factor: 11.195
Authors: Ahmed A Kolkailah; Rabah S Alreshq; Ahmed M Muhammed; Mohamed E Zahran; Marwah Anas El-Wegoud; Ashraf F Nabhan Journal: Cochrane Database Syst Rev Date: 2018-04-18
Authors: Karen A García-Rueda; César H Cediel-Barrera; Maribel Plaza-Tenorio; John U Cataño-Bedoya; Juan C Ortiz-Uribe; Keyner Toro-Osorio; Mailyn Peña-Pineda; Juan M Senior-Sánchez Journal: Arch Cardiol Mex Date: 2022-04-04