Radial vs Femoral Access After Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction. Thirty-day and One-year Mortality Results

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• 作者：Alberto Ruano-Ravina ; Guillermo Aldama-L贸pez ; Bel茅n Cid-脕lvarez ; Pablo Pi帽贸n-Esteban ; Diego L贸pez-Otero ; Ram贸n Calvi帽o-Santos ; Raymundo Ocaranza-S谩nchez ; Nicol谩s V谩zquez-Gonz谩lez ; Ramiro Trillo-Nouche ; Estrella L贸pez-Pardo
• 关键词：Myocardial infarction ; Percutaneous coronary intervention ; Retrospective cohort ; Mortality
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：November, 2013
• 年：2013
• 卷：66
• 期：11
• 页码：871-878
• 全文大小：266 K

文摘

Introduction and objectives

Little attention has been given to the effect of vascular access site on mortality, while an increasing body of evidence is showing that radial access has much more benefit than femoral access for ST-segment elevation myocardial infarction patients. We aimed to assess the influence of vascular access site on mortality at 30 days and at 1 year in ST-segment elevation myocardial infarction patients.

Methods

We included all patients with ST-segment elevation myocardial infarction who had undergone primary angioplasty at 2 Galician hospitals between 2008 and 2010. We performed 2 multivariate regression models for each endpoint (30-day and 1-year mortality). The only difference between these models was the inclusion or not of the vascular access site (femoral vs radial). For each of the 4 models we calculated the Hosmer-Lemeshow test and the C-index. We also tested the interaction between hemodynamic instability and vascular access.

Results

We included 1461 patients with a mean age of 64. Of these patients, 86% had radial access and 7.4% had hemodynamic instability. All-cause mortality was 6.8% (100/1461) at 30 days and 9.3% (136/1461) at 1 year. Vascular access site follows hemodynamic instability and age in terms of effect on mortality risk, with an odds ratio of 5.20 (95% confidence interval, 2.80-9.66) for 30-day mortality. A similar effect occurs for 1-year mortality. The C-index slightly improves (without achieving statistical significance) with the inclusion of the vascular access site.

Conclusions

Vascular access site should be taken into account when predicting mortality after a primary percutaneous coronary intervention.