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Dang D, Dowling C, Zaman S, Cameron J, Kuhn L. Predictors of radial to femoral artery crossover during primary percutaneous coronary intervention in ST-elevation myocardial infarction: A systematic review and meta-analysis. Aust Crit Care 2023; 36:915-923. [PMID: 36496332 DOI: 10.1016/j.aucc.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In contrast to traditional femoral artery access, radial artery access for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding but has higher crossover rates. Therefore, factors associated with crossover warrant exploration as crossover due to technical challenges associated with the radial route may be mitigated. OBJECTIVE The objective of this study was to identify predictors of radial access failure or crossover to femoral access in PPCI. METHODS A systematic review and meta-analysis was undertaken according to the Joanna Briggs Institute Systematic Reviews Checklist with searches conducted in Medline, EMBASE, CINAHL, and SCOPUS databases. Inclusion criteria for this study included patients with STEMI; PPCI; and primary research identifying predictors of radial access failures and/or crossovers, published in English, and after 2010. This study was registered with PROSPERO (CRD42020167122). Statistical analysis was performed using IBM SPSS Statistics for Windows version 26.0 (IBM Corp, Armonk, NY) and RevMan version 5.4 (Cochrane Collaboration, London, United Kingdom) with meta-analysis conducted by using the DerSimonian and Laird random-effects method. The National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilised for quality and risk of bias assessment, with EndNote software used for citations. RESULTS Eight observational studies met inclusion criteria, comprising 12,621 patients. Risk of bias of these studies was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The mean age was 61.2 ± 12.0 years, and 75.3% were male. Crossover from transradial to transfemoral artery occurred in 529 (4.2%) patients. Reasons for radial access failure included failed puncture (35.3%), peripheral occlusion or tortuosity (24.5%), and radial artery spasm (20.1%). Predictors of crossover included older age (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.44-2.65; p < 0.001), female sex (OR, 2.10; 95% Cl, 1.58-2.80; p < 0.001), weight ≤65 kg (OR, 2.95; 95% CI, 1.95-4.46; p < 0.001), and previous percutaneous coronary intervention (OR, 2.80; 95% Cl, 1.74-4.52; p < 0.001). CONCLUSION Older age, female sex, weight ≤65 kg, and previous percutaneous coronary intervention were predictors of crossover or failure from the radial to femoral artery. As these predictors are known to be associated with high bleeding and mortality, they should not preclude attempting a radial-first approach in all patients with STEMI. However, as these results were unadjusted, this study warrants further research to thoroughly investigate predictors of radial artery crossover.
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Affiliation(s)
- Denee Dang
- School of Nursing and Midwifery, Monash University, Melbourne, Australia; MonashHeart, Monash Health, Melbourne, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Cameron Dowling
- MonashHeart, Monash Health, Melbourne, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Cardiology Department, Westmead Hospital, Sydney, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Jan Cameron
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Melbourne, Australia; Monash Emergency Research Collaborative, Monash Health, Melbourne, Australia
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Balfe C, Jacob B, Morad S, Elsayed A, Tan LYJ, Nelson E, AlBaghdadi A, Power A, Twomey D, McDermott B, Ahern C, Abbas SF, Hennessy T, Ullah I, Arnous S, Kiernan T. Clinical Outcomes and Associations With Radial to Femoral Crossover in ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 200:103-111. [PMID: 37307779 DOI: 10.1016/j.amjcard.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/13/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
Radial access during primary percutaneous coronary intervention is associated with reduced mortality and major bleeding compared with femoral access and is the recommended access site. Nevertheless, failure to secure radial access may necessitate crossover to femoral access. This study aimed to identify the associations with crossover from radial to femoral access in all comers with ST-elevation myocardial infarction and to compare the clinical outcomes with those patients who did not require crossover. From 2016 to 2021, a total of 1,202 patients presented to our institute with ST-elevation myocardial infarction. Associations, clinical outcomes, and independent predictors of crossover from radial to femoral access were identified. From 1,202 patients, radial access was used in 1,138 patients (94.7%) and crossover to femoral access occurred in 64 patients (5.3%). Patients who required crossover to femoral access had higher rates of access site complications and longer length of stay in the hospital. Inpatient mortality was higher in the group requiring a crossover. This study identified 3 independent predictors of crossover from radial to femoral access in primary percutaneous coronary intervention: cardiogenic shock, cardiac arrest before arrival at the catheterization laboratory, and previous coronary artery bypass grafting. Biochemical infarct size and peak creatinine was also found to be higher in those requiring crossover. In conclusion, crossover in this study portended an increased rate of access site complications, greatly prolonged length of stay, and a significantly higher risk of death.
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Affiliation(s)
- Christopher Balfe
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland.
| | - Benjamin Jacob
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Samir Morad
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Amged Elsayed
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Lok Yi Joyce Tan
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Edel Nelson
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Ali AlBaghdadi
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Aoife Power
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - David Twomey
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Breda McDermott
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Catriona Ahern
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Syed Farhat Abbas
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Terence Hennessy
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Ihsan Ullah
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Samer Arnous
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Thomas Kiernan
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland; School of Medicine, University of Limerick, Co. Limerick, Ireland
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3
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Sattar Y, Majmundar M, Ullah W, Mamtani S, Kumar A, Robinson S, Zghouzi M, Mir T, Dhamrah U, Al-Khadra Y, Pacha HM, Darmoch F, Soud M, Hakim Z, Bagur R, Kaul P, Ijioma N, Panchal A, Shroff AR, Alraies MC. Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:433-444. [PMID: 33896335 DOI: 10.1080/14779072.2021.1915768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial. METHODS PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model. RESULTS We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year. CONCLUSION TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Monil Majmundar
- New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sahil Mamtani
- Internal Medicine, Atlantic Care Regional Medical Center, Atlantic City, NJ, USA
| | - Ashish Kumar
- Internal Medicine, St John's Medical College Hospital, Bangalore, India
| | - Sam Robinson
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Umaima Dhamrah
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Yasser Al-Khadra
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Homam Moussa Pacha
- McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Heart & Vascular Institute, Houston, TX, USA
| | - Fahed Darmoch
- Internal Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Zaher Hakim
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Rodrigo Bagur
- London Health Science Centre, Western University, London, Canada
| | - Prashant Kaul
- Department of Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Ankur Panchal
- Department of Cardiology, University of Pittsburgh Medical Center, PA, USA
| | - Adhir R Shroff
- Department of Cardiology, University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, IL, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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4
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Ruiz-Rodriguez E, Asfour A, Lolay G, Ziada KM, Abdel-Latif AK. Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome. South Med J 2016; 109:61-76. [PMID: 26741877 DOI: 10.14423/smj.0000000000000404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are needed. This systematic review and meta-analysis aims to compare major cardiovascular outcomes and safety endpoints in patients with ACS managed with PCI using radial versus femoral access. METHODS Randomized controlled trials and cohort studies comparing RA versus FA in patients with ACS were analyzed. Our primary outcomes were mortality, major adverse cardiac event, major bleeding, and access-related complications. A fixed-effects model was used for the primary analyses. RESULTS Fifteen randomized controlled trials and 17 cohort studies involving 44,854 patients with ACS were identified. Compared with FA, RA was associated with a reduction in major bleeding (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.33-0.61, P < 0.001), access-related complications (OR 0.27, 95% CI 0.18-0.39, P < 0.001), mortality (OR 0.64, 95% CI 0.54-0.75, P < 0.001), and major adverse cardiac event (OR 0.70, 95% CI 0.57-0.85, P < 0.001). These significant reductions were consistent across different study designs and clinical presentations. CONCLUSIONS Based on this large meta-analysis, RA for primary PCI in the setting of ACS is associated with reduction in cardiac and safety endpoints when compared with FA in both urgent and elective procedures. This should encourage a wider adoption of this technique among centers and interventional cardiologists.
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Affiliation(s)
- Ernesto Ruiz-Rodriguez
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed Asfour
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Georges Lolay
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Khaled M Ziada
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed K Abdel-Latif
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
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5
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Abdelaal E, MacHaalany J, Plourde G, Barria Perez A, Bouchard MP, Roy M, Déry JP, Déry U, Barbeau G, Larose É, Gleeton O, Noël B, Rodés-Cabau J, Roy L, Costerousse O, Bertrand OF. Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention. Heart 2016; 102:919-25. [DOI: 10.1136/heartjnl-2015-308371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 03/02/2016] [Indexed: 11/03/2022] Open
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Roule V, Lemaitre A, Sabatier R, Lognoné T, Dahdouh Z, Berger L, Milliez P, Grollier G, Montalescot G, Beygui F. Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies. Arch Cardiovasc Dis 2015; 108:563-75. [PMID: 26365478 DOI: 10.1016/j.acvd.2015.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials. AIMS To compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach. METHODS A prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed. RESULTS Patients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28-0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31-0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13-0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58-0.68) and major bleeding (RR: 0.43, 95%CI: 0.32-0.59). CONCLUSION The transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres.
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Affiliation(s)
- Vincent Roule
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Adrien Lemaitre
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Rémi Sabatier
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Thérèse Lognoné
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Ziad Dahdouh
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Ludovic Berger
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Paul Milliez
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Gilles Grollier
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Gilles Montalescot
- ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France
| | - Farzin Beygui
- Cardiology Department, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France; ACTION academic group, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, 75013 Paris, France.
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Anderson SG, Ratib K, Myint PK, Keavney B, Kwok CS, Zaman A, Ludman PF, de Belder MA, Nolan J, Mamas MA. Impact of age on access site-related outcomes in 469,983 percutaneous coronary intervention procedures: Insights from the British Cardiovascular Intervention Society. Catheter Cardiovasc Interv 2015; 86:965-72. [DOI: 10.1002/ccd.25896] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/08/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Simon G. Anderson
- Manchester Heart Centre, Manchester Royal Infirmary; Manchester United Kingdom
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Karim Ratib
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent, North Staffordshire United Kingdom
| | - Phyo K. Myint
- Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen; Aberdeen Scotland United Kingdom
| | - Bernard Keavney
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
| | - Azfar Zaman
- Department of Cardiology; Freeman Hospital; Newcastle Upon Tyne and Institute of Cellular Medicine, Newcastle University; Newcastle United Kingdom
| | - Peter F. Ludman
- Department of Cardiology; Queen Elizabeth Hospital, Edgbaston; Birmingham United Kingdom
| | - Mark A. de Belder
- Department of Cardiology; The James Cook University Hospital; Middlesbrough United Kingdom
| | - James Nolan
- Department of Cardiology; University Hospital of North Staffordshire; Stoke-on-Trent, North Staffordshire United Kingdom
| | - Mamas A. Mamas
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester; Manchester United Kingdom
- Farr Institute; Institute of Population Health; University of Manchester; Manchester United Kingdom
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8
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Hung MJ, Mao CT, Kao YC, Hung MY. Delayed onset of forearm compartment syndrome after transradial percutaneous coronary intervention. Int J Cardiol 2015; 178:77-8. [PMID: 25464223 DOI: 10.1016/j.ijcard.2014.10.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ming-Jui Hung
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Tai Mao
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Cheng Kao
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Yow Hung
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
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9
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Pang J, Zhang Z, Yang YJ, Li N, Bai M, Peng Y, Zhang J, Li Q, Zhang B. The efficacy and safety of transradial percutaneous coronary intervention VS transfemoral percutaneous coronary intervention for ST-segment elevation myocardial infarction patients: A meta-analysis. Int J Cardiol 2014; 177:483-8. [DOI: 10.1016/j.ijcard.2014.04.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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RUBARTELLI PAOLO, CRIMI GABRIELE, BARTOLINI DAVIDE, BELLOTTI SANDRO, IANNONE ALESSANDRO, FONTANA VINCENZO. Switching from Femoral to Routine Radial Access Site for ST-Elevation Myocardial Infarction:
A Single Center Experience. J Interv Cardiol 2014; 27:591-9. [DOI: 10.1111/joic.12157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- PAOLO RUBARTELLI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - GABRIELE CRIMI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - DAVIDE BARTOLINI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - SANDRO BELLOTTI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | | | - VINCENZO FONTANA
- Epidemiology, Biostatistics and Clinical Trials Unit; IRCCS AOU San Martino - IST; Genoa Italy
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11
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Mizuguchi Y, Takahashi A, Yamada T, Taniguchi N, Nakajima S, Hata T. Feasibility of transradial coronary intervention in patients with cardiac arrest caused by acute coronary syndrome. Int J Cardiol 2014; 172:e255-7. [DOI: 10.1016/j.ijcard.2013.12.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
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12
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Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Labata C, Oliete C, Rivas MDC, Bayes-Genis A. Results of primary percutaneous coronary intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol 2014; 113:452-6. [PMID: 24315363 DOI: 10.1016/j.amjcard.2013.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 12/01/2022]
Abstract
Previous trials in elderly patients with ST-elevation myocardial infarction (STEMI) have not shown a definitive benefit of primary percutaneous coronary intervention (PPCI) by transfemoral approach over thrombolysis. The transradial approach (TRA) is associated with a significant decrease in mortality, MACE (Major Adverse Cardiac Event), and serious access site complications compared with the transfemoral approach. We have evaluated clinical outcomes in a cohort of real-life unselected ≥75-year-old patients with STEMI treated by TRA-PPCI. This is a single-center prospective, observational registry of consecutive patients with STEMI who underwent PPCI between February 2007 and February 2013. MACE was defined as death, reinfarction, or stroke. A total of 307 patients were treated by PPCI, 293 (95.1%) with TRA-PPCI (mean age 80 ± 2 years, 42% women). Patients had high co-morbidity levels (cardiogenic shock on admission 8.5%, previous myocardial infarction 11.6%, diabetes 30.4%, previous renal failure 25.6%, previous PCI 9.6%, and peripheral arterial disease 14.3%); IIbIIIa inhibitors were used in 45.1% of patients. Severe bleeding and need for transfusion were recorded for 6.5% and 9.9% of patients, respectively. In-hospital mortality, 1-year mortality, and 1-year MACE were 11.9%, 17.4%, and 22.2%, respectively. Excluding 25 patients with cardiogenic shock on admission, the in-hospital mortality, 1-year mortality, and 1-year MACE were 7.8%, 13.1%, and 17.9%, respectively. In conclusion, TRA-PPCI was feasible in the vast majority of elderly patients with STEMI. In-hospital mortality, 1-year mortality, and 1-year MACE were lower than reported for transfemoral access, suggesting a benefit of the TRA in these patients.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Spain.
| | | | - Xavier Carrillo
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josepa Mauri
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carlos Labata
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carolina Oliete
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antoni Bayes-Genis
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut per la Recerca Germans Trias i Pujol, Badalona, Spain
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