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Radial Approach to PCI Associated With Less Bleeding Relative to the Femoral Approach: Presented at CCC

EDMONTON, Alberta -- October 27, 2009 -- A relatively large case series suggests the radial approach to primary percutaneous coronary interventions (PCI) is preferable to the more commonly used femoral approach. In particular, major bleeding occurred in only 2.9% of those receiving the radial approach versus 13.5% (P < .001) receiving the femoral approach, according to results presented here October 25 at the 2009 Canadian Cardiovascular Congress (CCC).

"This study demonstrates a significantly lower incidence of major bleeding by using a radial approach without compromising the time to reperfusion," reported Dabit Arzamendi, MD, Montreal Heart Institute, Montreal, Quebec, Canada, who identified major bleeding as one of the most significant complications of PCI. He indicated that these results are consistent with several smaller studies that have also favoured a radial over a femoral approach to PCI for the same reason.

In this study, all primary PCIs conducted to treat a ST elevation myocardial infarction (STEMI) over a 1-year period (April 2007 to March 2008) were analysed for outcome based on whether a radial or femoral approach was employed. Of the 488 patients included, 236 (48.4%) were treated with a radial approach and 252 (51.6%) were treated with a femoral approach. No differences were found in a large array of baseline characteristics evaluated, including age, gender, cardiovascular risk factors, TIMI flow prior to procedure, and haemodynamic values at admission. The time from arrival in the catheterisation lab to the PCI puncture was 8.15 minutes for the radial approach and 8.8 minutes for the femoral approach, which did not differ significantly.

When evaluated with a multivariate analysis, the approach to PCI remained a highly significant predictor of bleeding, producing a hazard ratio of 5.86 (95% confidence interval 2.4-14.3; P < .001). Although the length of the procedure increased by 3 minutes in the radial versus the femoral group, which did reach statistical significance (P < .05), outcomes other than bleeding rates, such as rates of reperfusion rates and acute events, were comparable.

According to Dr. Arzamendi, these results strongly suggest that the radial approach is superior, but he noted that interventional cardiologists are often slow to change the approach with which they were trained. As a result, he suggested that the transition to the radial approach may be slow. However, if a prospective, multicentre study now comparing the radial and femoral approach substantiates these observational results, the process is likely to accelerate.

CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.

[Presentation title: The Radial Approach Reduces Bleeding Complications in STEMI Patients Without Increasing the Time to Revascularization. Abstract 462]

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