Radial access for PCI in STEMI patients increasing, associated with less bleeding

March 4, 2013 – The DCRI’s Sunil Rao, MD, analyzed patient data from the CathPCI Registry to compare rates of radial access and femoral access PCI between 2007 and 2011.

Radial artery access is associated with lower bleeding rates and reduced rates of in-hospital death among patients with ST-segment elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI).

That is the conclusion of a study published in the January 29 issue of the Journal of the American College of Cardiology. The study was conducted by the DCRI’s Lisa Kaltenbach, MS; Sumeet Subherwal, MD; and Sunil Rao, MD; and researchers from other institutions. Rao was senior author of the study.

A STEMI is a type of heart attack in which the blood vessel becomes completely obstructed. STEMI patients are frequently treated with PCI, a nonsurgical procedure in which a catheter is inserted into the affected blood vessel to break up the obstruction. Although the use of PCI has successfully lowered death rates among patients with STEMI, the procedure has also been associated with an increased risk of bleeding. Previous studies have suggested that the risk of bleeding is related to where the catheter is inserted; physicians typically insert it into the radial or the femoral artery. However, these studies do not agree on which approach is safer for patients.

To better understand how catheterization access site relates to risk of bleeding and other adverse outcomes, the DCRI researchers and their colleagues examined patient data from the National Cardiovascular Data Registry (NCDR). The data set included STEMI patients who underwent PCI between 2007 and 2011. After excluding non-relevant cases, the researchers had a final study population of 90,879 patients who were treated at 541 sites across the United States.

After performing a statistical analysis, the researchers discovered that although radial access for patients with STEMI is far less prevalent than femoral access, the use of the former is growing rapidly. Between 2007 and 2011, rates of radial access PCI increased from 0.9 percent to 6.4 percent in the United States. The researchers also found that compared with femoral access, use of radial access for STEMI PCI was associated with slightly longer procedure time but reduced bleeding and in-hospital mortality. They noted that concerns about lengthy reperfusion times, difficulty with navigating the radial artery, and inability to use larger catheters are potential reasons why radial access is still relatively rare in clinical practice. Overall, there was no difference in the success of the procedure between radial and femoral access cases.

The researchers concluded that wider use of radial PCI should be considered by physicians, although randomized trials are needed to confirm this finding.