The following is a summary of “Clinical Outcomes and Associations With Radial to Femoral Crossover in ST-Elevation Myocardial Infarction,” published in the August 2023 issue of the Cardiovascular Disease by Balfe et al.
Radial access during primary percutaneous coronary intervention (PCI) correlates with decreased mortality and major bleeding compared to femoral access, making it the recommended access site. However, the inability to obtain a radial permit may require switching to femoral access. This study aimed to identify the correlations related to the transition from radial to femoral access in all individuals diagnosed with ST-elevation myocardial infarction. Additionally, the study aimed to compare the clinical outcomes between patients who required crossover and those who did not. From 2016 to 2021, 1,202 individuals sought medical attention at researcher’s institution due to ST-elevation myocardial infarction. Associations, clinical outcomes, and independent predictors of transitioning from radial to femoral access were identified.
Out of 1,202 patients, radial access was employed in 1,138 (94.7%), while 64 patients (5.3%) required a transition to femoral access. Patients who necessitated crossover to femoral access exhibited elevated frequencies of access site complications and experienced an extended duration of hospitalization. The group necessitating a crossover showed a higher rate of inpatient mortality.
This study has identified three autonomous predictors of transition from radial to femoral access in primary percutaneous coronary intervention: cardiogenic shock, cardiac arrest before arrival at the catheterization laboratory, and prior coronary artery bypass grafting. The size of the biochemical infarct and the peak creatinine levels were elevated in individuals who necessitated crossover. In summary, the occurrence of crossover in this study indicated a heightened incidence of access site complications, significantly extended hospitalization duration, and a notably elevated mortality risk.
Source: sciencedirect.com/science/article/abs/pii/S0002914923003028
