scholarly journals Radial access versus femoral access in myocardial infarction – a single-center experience

2019 ◽  
Vol 88 (7-8) ◽  
pp. 327-337
Author(s):  
Vojko Kanič ◽  
Igor Balevski ◽  
Samo Granda ◽  
Franjo Husam Naji ◽  
Igor Krajnc ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Confounding Factors ◽  
Femoral Access ◽  
Radial Access ◽  
Single Center Experience ◽  
Contrast Volume ◽  
Percutaneous Coronary ◽  
The Difference

Background Data on the relationship between radial access (RA) and outcome in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) are inconclusive. The aim of our study was to assess whether RA is associated with 30-day mortality in patients with MI undergoing percutaneous coronary intervention in our center or whether the possible benefit of RA is the result of less bleeding and other confounding factors. Methods We retrospectively studied 3501 consecutive patients with MI who underwent PCI between January 2012 and December 2016. The 30-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics. Results RA patients had a significantly lower 30-day unadjusted mortality [53(3.8%) patients died in the RA group compared to 207(9.8%) patients in the FA group; p<0.0001]. After adjustments for confounders, the difference was no longer significant (adjusted OR: 0.84; 95% CI: 0.58 to 1.22). Cardiogenic shock, age over 70 years, hypertension, hyperlipidemia, anemia on admission, renal dysfunction on admission, ST-elevation MI, bleeding, the contrast volume/GFR ratio, but not RA, predicted 30-day mortality.   Conclusion RA was not associated with 30-day mortality in patients with MI undergoing PCI. Our study result suggests that the better outcome in the RA group was influenced by confounding factors, especially bleeding and hemodynamic impairment.          

scholarly journals Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jörg Reifart ◽  
Stefan Göhring ◽  
Alexander Albrecht ◽  
Winfried Haerer ◽  
Benny Levenson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Invasive Cardiology ◽  
Percutaneous Coronary

Abstract Background In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. Methods The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. Results From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). Conclusion Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

scholarly journals Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction

2015 ◽  
Vol 5 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Hoon Suk Park ◽  
Chan Joon Kim ◽  
Jeong-Eun Yi ◽  
Byung-Hee Hwang ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Roc Curve ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Contrast Volume ◽  
Percutaneous Coronary

Background: Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). Methods: This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. Results: The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Conclusions: Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.

scholarly journals Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction

2021 ◽  
Vol 10 (15) ◽  
pp. 3438
Author(s):  
Oh-Hyun Lee ◽  
Yongcheol Kim ◽  
Nak-Hoon Son ◽  
Ji Woong Roh ◽  
Eui Im ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Feasible Alternative ◽  
Experienced Operator ◽  
St Elevation

Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.

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