Transradial Versus Transfemoral Coronary Intervention for Acute ST- Elevation Myocardial Infarction patients undergoing primary PCI

Abstract

Background:Patients with ST-segment elevation myocardial infarction (STEMI) require an urgent
revascularization strategy as well as aggressive antiplatelet and antithrombotic pharmacotherapy and
thus are particularly susceptible to bleeding complications.This study aimed toassess and compare the
feasibility, success and safety of transradial approach (TRA) versus transfemoral approach (TFA) in
STEMI patients undergoing 1ry PCI regarding clinical outcomes and vascular complications. Patients
and methods:This randomized controlled study included 80 patients who were admitted to the
National Heart Institute in the period between May 2015 to September 2017, because of ST-elevation
myocardial infarction (STEMI) andwere planned for 1ry PCI. Patients were divided into two groups,
each group included 40 patients. Group I; underwent tarnsradial PCI and Group II; underwent
tarnsfemoral PCI. We compared between both groups as regards in hospital major bleeding & vascular
complications and followed up for 3 months for (MACE). Results: The primary end points were
statistically insignificant in both groups however large access site hematoma occurred in 3 patients in
TFA group compared to none of patients in TRA group. Additionally, one case had gastrointestinal
hemorrhage in TFA group compared to none of patients in TRA group. The secondary end points:
major adverse cardiac events (MACE) during the in-hospital stay & 3 months follow up were
statistically not significant in both groups. However, one case of mortality occurred in TFA group
while no cases occurred in TRA group. The range of patients hospital stay was from 1 to 3 days with
mean 2.10.38, while inTRAgroup.While itwas from 2 to 6 days with mean 3.91.0 in TFA group, and
that was statistically highly significant (P 0.001).Conclusions:1ryPCI for STEMI can be performed via
RA with DTBs clinically equivalent to those performed from FA after adequate experience and training.