The Prevalence and Outcomes of Transradial Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Analysis From the NCDR (2007 to 2011)
What are the prevalence and outcomes of radial percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in the United States?
The authors assessed the use of radial versus femoral access among 294,769 patients undergoing PCI for STEMI at 1,204 hospitals in the CathPCI Registry between 2007 and 2011. Patients were grouped according to access site used for PCI. An inverse probability weighting analysis incorporating propensity scores was used to compare procedural success, post-PCI bleeding, door-to-balloon times, and in-hospital mortality between radial and femoral access.
Over the 5-year study period, the use of radial access in STEMI increased from 0.9% to 6.4% (p < 0.0001). There was no difference in procedural success. Radial access was associated with slightly longer median door-to-balloon time (78 vs. 74 minute; p < 0.0001) and lower adjusted risk of bleeding (odds ratio, 0.62; 95% confidence interval, 0.53-0.72; p < 0.0001). There was a trend toward lower adjusted risk of in-hospital mortality (odds ratio, 0.76; 95% confidence interval, 0.57-0.99; p < 0.0455).
The authors concluded that radial PCI is increasing in use, and is associated with a lower risk of bleeding and death in patients undergoing PCI for STEMI.
This study suggests that radial PCI is being used more frequently for PCI in STEMI, and there appears to be an association between use of radial PCI and decreased mortality. The magnitude of the survival benefit seen in this study belies biological plausibility, and I doubt that switching to radial PCI will result in a 24% reduction in mortality. It is likely that radial PCI is being used selectively in a healthier subset of patients, and the study has failed to completely adjust for confounding. It seems prudent to wait for adequately powered randomized data before switching to routine use of radial PCI for primary PCI.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention
Keywords: Prevalence, Odds Ratio, Registries, Myocardial Infarction, Propensity Score, Hospital Mortality, Cardiovascular Diseases, Confidence Intervals, Angioplasty, Hemorrhage, United States, Percutaneous Coronary Intervention
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