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

  1. Ruano-Ravina, Alberto 1
  2. Aldama-López, Guillermo 2
  3. Cid-Álvarez, Belén 4
  4. Piñón-Esteban, Pablo 2
  5. López-Otero, Diego 4
  6. Calviño-Santos, Ramón 2
  7. Ocaranza-Sánchez, Raymundo 4
  8. Vázquez-González, Nicolás 2
  9. Trillo-Nouche, Ramiro 4
  10. López-Pardo, Estrella 3
  1. 1 Univ Santiago de Compostela, Fac Med, Area Med Prevent & Salud Publ, Santiago De Compostela 15782, A Coruna, Spain
  2. 2 Complejo Hosp Univ A Coruna, Serv Cardiol, Unidad Cardiol Intervencionista, La Coruna, Spain
  3. 3 Serv Gallego Salud, Subdirecc Calidad Atenc Paciente & Admis, Santiago De Compostela, A Coruna, Spain
  4. 4 Complejo Hosp Univ Santiago de Compostela, Serv Cardiol, Unidad Cardiol Intervencionista, Santiago De Compostela, A Coruna, Spain
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Revista:
Revista Española de Cardiología (English Edition)

ISSN: 1885-5857

Ano de publicación: 2013

Volume: 66

Número: 11

Páxinas: 871-878

Tipo: Artigo

DOI: 10.1016/J.REC.2013.05.029 GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Revista Española de Cardiología (English Edition)

Resumo

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. (C) 2013 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.

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Spanish Ministry of Health, Social Services, and Equality within the framework of the Quality Plan of the National Health Service

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