• Timm Bauer, Matthias Hochadel, Johannes Brachmann, Volker Schächinger, Peter Boekstegers, Bernhard Zrenner, Ralf Zahn, Uwe Zeymer, and Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK).
• Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.
• Catheter Cardiovasc Interv. 2015 Oct 1; 86 Suppl 1: S8-14.

ObjectivesThis study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice.BackgroundThe radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use.MethodsBetween 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%).ResultsProcedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P < 0.001) and vascular access complications (0.3 vs. 1.8%, P < 0.001%) were lower in the TR group. In the multivariate analysis radial access was associated with an improved in-hospital survival rate (OR 0.47, 95% CI 0.35-0.65).ConclusionsThe radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality.© 2015 Wiley Periodicals, Inc.

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