Background: Radial access for PCI can reduce vascular bleeding compared with femoral access, and this result in lowering major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute myocardial infarction (AMI). However, it is unclear whether radial compared with femoral access with or without vascular closure device improves MACCE after AMI in real world practice.
Methods: We examined 11,600 patients who underwent PCI through radial or femoral access from the Korean Acute Myocardial Infarction Registry (KAMIR) - National Institute of Health (NIH) database. In-hospital MACCE was defined as in-hospital death, major bleeding, and cerebrovascular accidents. Because the patients were not randomly assigned to vascular access sites, propensity-score (PS) matching was performed to reduce the effect of treatment-selection bias and potential confounding factors. This research was supported by a fund (2013-E63005-02) by Research of Korea Centers for Disease Control and Prevention.
Results: For each patient, a PS indicating the likelihood of using radial access during PCI was calculated using a non-parsimonious multivariable logistic regression model, leaving 3,495 radial versus 3,495 femoral accesses. Compared with femoral access, radial access significantly reduced in-hospital MACCEs (2.2% versus 3.8%; odds ratio [OR] 0.56, 95% confidence interval [CI] 0.42 - 0.74; p <0.001), and the difference was mainly driven by major bleeding (0.6% versus 2.2%; p < 0.001). Therefore, we compared radial (n=2,153) to femoral access with vascular closure device (n=2,153) after PS matching. There were no significant differences in MACCEs (2.6% versus 2.3%, p=0.493) and major bleeding (0.6% versus 0.9%, p=0.287). However, compared radial (n=2,572) to femoral access without vascular device (n=2,572), there were significant differences in MACCEs (2.7% versus 4.9%; OR 0.55; 95%CI 0.41 - 0.74; p<0.001) and major bleeding (0.7% versus 3.0%; OR 0.22; 95%CI 0.13 - 0.37; p<0.001).
Conclusion: In patients with AMI, radial as compared with femoral access reduces In-hospital event through a reduction in major bleeding. Various efforts reducing major bleeding would improve clinical outcome, particularly in new antiplatelet agent era.