COMPARISON OF OUTCOMES IN PRIMARY PCI ACCORDING TO ARTERIAL ACCESS SITE: A FOUR-YEAR SINGLE CENTRE OBSERVATIONAL STUDY

Abstract

Objective: To compare outcomes following femoral artery (FA) and radial artery(RA) access for consecutive patients undergoing primary percutaneouscoronary intervention (PPCI) over a four-year observational period.

Methodology: This cross sectional study was conducted at University HospitalSouthampton . All PPCI cases performed at our center over a four-year period (1April 2008 to 31 March 2012) were rewired. Patients more than 18 years of agewere included . Procedural decisions including access site, device selection, useof adjunctive pharmacotherapy and type of stent were at the operator discretion.Cardiologists delivering the PPCI service, three used RA access , while the otherthree used FA access and outcomes between these two groups was recorded. Alldata were analysed using SPSS statistical software, (Version 20.0, IBMCorporation, Armonk, NY, USA).

Result: Our study included 961 patients (64±12 years, 76% males). There wasno significant difference in door-to-balloon times, radiation dose or in-hospitallength of stay between the RA and FA groups. In-hospital mortality rates werehigher in FA group vs. RA group (6.8% vs. 2.0%, p=0.009). However, followingthe exclusion of cardiogenic shock patients, the in-hospital mortality rates wereno different, 2.4% vs. 4.3%, (p=0.10). There was a higher rate of combinedvascular complications in the FA group (1.4% vs. 0%, p=0.05). RA access wasassociated with a higher screening time (minutes) 9 (3 to 15) vs. 7.5 (0.5 to 14.5)(p<0.0001) and access site failure 2.8% vs. 0.1% (p<0.0001).

Conclusion: Our data demonstrates that in patients without cardiogenic shockundergoing PPCI, there is no significant difference in outcomes for FA versus RAaccess.