Less Bleeding, Lower In-Hospital Mortality With Transradial PCI for STEMI

December 21, 2012

ANN ARBOR, Michigan — The use of transradial PCI for the treatment of ST-segment elevation MI (STEMI) is on the rise in US clinical practice but still represents a very small percentage of overall PCI procedures. Over a recent five-year period, the use of radial-artery access for STEMI PCI increased from 0.9% to 6.4% and was associated with a significant reduction in the risk of bleeding and in-hospital mortality, report investigators [1].

In a report published online December 19, 2012 in the Journal of the American College of Cardiology, Dr Dmitri Baklanov (Saint Luke's Mid America Heart Institute, Kansas City, MO) and colleagues say the data suggest that a wider adoption of transradial PCI for STEMI patients may improve clinical outcomes but caution that the results need to be confirmed in an adequately powered clinical trial.

These latest data are taken from an analysis of the National Cardiovascular Data Registry (NCDR). In total, 294 769 patients underwent PCI for STEMI at 1204 hospitals in the CathPCI Registry between 2007 and 2011. As noted, there was an absolute 5.5% increase in the utilization of transradial PCI in this five-year period. Radial-access PCI was associated with longer door-to-balloon times, in this case 78 minutes vs 74 minutes for transfemoral PCI (p<0.0001).

Despite the longer door-to-balloon times, transradial PCI was associated with a significant 38% lower risk of bleeding (odds ratio [OR] 0.62, p<0.0001) and a 24% lower risk of in-hospital mortality (OR 0.76, p<0.045).

Previous studies that have not included STEMI patients have shown that transradial PCI reduces the risk of bleeding and complications, but there have been concerns about the procedure in STEMI patients given the learning curve associated with the approach and the possibility of increased procedure times for a patient population where time to reperfusion is critical, note the researchers.

In the STEMI subgroup of the RIVAL trial, however, for individuals presenting to the hospital within 12 hours of STEMI, radial-access PCI was associated with a lower rate of major bleeding and access-site complications, as well as a significant increase in net clinical benefit. The 30-day net adverse clinical event rate, which included major adverse cardiac events (MACE) plus major bleeding, was 58% lower in the radial-access PCI arm, although there was no difference in the MACE rate alone. In the study's presentation at TCT 2012, the RIVAL investigators noted that transradial PCI was performed by experienced operators, with the interventionalists all performing 80% of their cases via the radial artery.