• Rev Esp Cardiol (Engl Ed) · Nov 2013

    Comparative Study

    Radial vs femoral access after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Thirty-day and one-year mortality results.

    • Alberto Ruano-Ravina, Guillermo Aldama-López, Belén Cid-Álvarez, Pablo Piñón-Esteban, Diego López-Otero, Ramón Calviño-Santos, Raymundo Ocaranza-Sánchez, Nicolás Vázquez-González, Ramiro Trillo-Nouche, and Estrella López-Pardo.
    • Área de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Spain. Electronic address: alberto.ruano@usc.es.
    • Rev Esp Cardiol (Engl Ed). 2013 Nov 1;66(11):871-8.

    Introduction And ObjectivesLittle 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.MethodsWe 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.ResultsWe 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.ConclusionsVascular access site should be taken into account when predicting mortality after a primary percutaneous coronary intervention.Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

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