Radial PCI Cuts Deaths, Repeat Interventions in STEMI Patients

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Compared with the transfemoral approach, percutaneous coronary intervention (PCI) via the transradial route is associated with reduced mortality at 2 years as well as less need for vascular surgery and/or blood transfusions, according to findings published in the January 2012 issue of JACC: Cardiovascular Interventions.

Researchers led by Marco Valgimigli, MD, PhD, of University of Ferrara (Ferrara, Italy), examined all patients treated with transfemoral (n = 8,000) or transradial (n = 3,068) PCI at 12 hospitals in Italy between January 1, 2003, and July 30, 2009. All patients were enrolled in the REAL (REgistro regionale AngiopLastiche dell’Emilia-Romagna) registry, a large, prospective, Internet-based study designed to collect clinical and angiographic data on all consecutive PCIs performed in a specific region of northern Italy.

Mortality Difference at 2 Years

After propensity score matching, there were 1,501 patient pairs. Transradial intervention was associated with a decreased rate of the primary outcome of mortality at 2 years compared with the transfemoral approach. Both the composite of death or MI and the composite of death, MI, or stroke also were lower in the transradial group, entirely driven by the observed difference in mortality (table 1).

Table 1. Two-Year Outcomes

Rates of major bleeding and vascular events requiring surgery at 30 days were reduced by more than half in the transradial group compared with the transfemoral group (1.1% vs. 2.5%; P = 0.0052).

Furthermore, adjusted outcomes based on propensity-score analysis of the entire population showed a 30% mortality reduction at 2 years in favor of the transradial approach. This reflected a significant mortality benefit at 30 days, whereas the death rate between 1 and 24 months did not differ. The composite endpoints also were significantly reduced at 2 years in the transradial group (table 2).

Table 2. Risk of Adverse Outcomes at 2 Years, Transfemoral vs. Transradial

 
Similarly, the adjusted 30-day rate of major bleeding or vascular events remained lower in the transradial group with no difference thereafter up to 24 months. The results were consistent across several prespecified covariates.

Further Research Needed for Confirmation

“Our study, in keeping with recent evidence, suggests that the risks of transitioning toward the transradial route over the conventional transfemoral approach in STEMI patients, provided the process is undertaken in a step-wise approach as part of a global [transradial intervention] program, may be largely outweighed by a lower mortality rate,” the study authors write.

“Although a causal relationship between the observed improved short-term safety profile and the lower 2-year fatality rate cannot be proven by our study, this hypothesis is of major potential relevance for the whole medical community,” they comment. “[I]t is currently being tested in the MATRIX (Minimizing Adverse hemorrhagic events by TRansradial access site and systemic Implementation of angioX) study.”

Study Details

Interventional strategy and device use, including stent type, were left to the discretion of the attending physicians. Periprocedural glycoprotein IIb/IIIa inhibitors and antithrombotic medications were used according to the operator’s discretion and current guidelines. Antiplatelet treatment included lifelong aspirin for all patients and at least 1 month of ticlopidine (250 mg twice a day) or clopidogrel (75 mg/day) in those who underwent stenting.

 

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Source:
Valgimigli M, Saia F, Guastaroba P, et al. Transradial versus transfemoral intervention for acute myocardial infarction. A propensity score-adjusted and -matched analysis from the REAL (REgistro regionale AngiopLastiche dell’Emilia-Romagna) multicenter registry. J Am Coll Cardiol Intv. 2012;5:23-35.

 

 

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