ISSN 2996-8215
International Journal of Cardiology | Vol. 14, No. 3, March 2023 | pp. 17–24
DOI: 10.46882/2023/IJC/000167
Original Research Article
Transradial versus Transfemoral Entry-Site Complications in Geriatric STEMI Patients Undergoing Primary Mechanical Revascularization
Giovanni Rossi¹, Matteo Bianchi¹, Antonio Ferrara²
¹Department of Cardiovascular Sciences, University Hospital of Bologna, Bologna, Italy
²Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy
Abstract:
Vascular access site complications significantly impact mortality after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI), particularly in elderly populations. This randomized clinical trial compared bleeding complications, procedural success, and net adverse clinical events between transradial access (TRA) and transfemoral access (TFA) in elderly STEMI patients. We randomized 260 consecutive patients aged greater than or equal to 75 years undergoing PPCI to either the TRA group (n = 130) or the TFA group (n = 130). The primary endpoint was a 30-day composite of major access-site bleeding or vascular complications according to BARC criteria. Procedural success rates did not differ significantly between cohorts (96.2% for TRA vs. 97.7% for TFA, p = 0.44). However, the primary safety endpoint was significantly lower in the transradial cohort than in the transfemoral cohort (1.5% vs. 6.9%, p = 0.03), driven by a distinct reduction in large access-site hematomas and vascular pseudoaneurysms. Total fluoroscopy time was slightly longer in the TRA arm (12.4 ± 3.4 minutes vs. 10.2 ± 2.8 minutes, p = 0.02). Post-procedural hospital stay was significantly shorter in the transradial group (3.2 ± 0.8 days vs. 4.8 ± 1.2 days, p < 0.01). Transradial access for primary percutaneous coronary intervention in elderly STEMI patients significantly minimizes entry-site vascular complications and shortens hospital stay without compromising mechanical revascularization success rates compared to transfemoral access.
Keywords: ST-segment elevation myocardial infarction, Primary percutaneous coronary intervention, Transradial access, Transfemoral access, Vascular complications, Elderly
Received: December 10, 2022; Revised: January 22, 2023; Accepted: February 11, 2023; Published: March 18, 2023