Omar Rana, Daniel Vawdrey, Lain Simpson, Alison Calver, Simon Corbett, James Wilkinson, Huon Gray, Nick Curzen.
Comparison of outcomes in primary PCI according to arterial access site: a four-year single centre observational study.
Pak Heart J Jan ;50(2):71-8.

Objective: To compare outcomes following femoral artery (FA) and radial artery(RA) access for consecutive patients undergoing primary percutaneous coronary intervention (PPCI) over a four-year observational period. Methodology: This cross sectional study was conducted at University Hospital Southampton. All PPCI cases performed at our center over a four-year period (1 April 2008 to 31 March 2012) were rewired. Patients more than 18 years of age were included. Procedural decisions including access site, device selection, use of adjunctive pharmacotherapy and type of stent were at the operator discretion. Cardiologists delivering the PPCI service, three used RA access , while the other three used FA access and outcomes between these two groups was recorded. All data were analysed using SPSS statistical software, (Version 20.0, IBM Corporation, Armonk, NY, USA). Result: Our study included 961 patients (64+-12 years, 76% males). There was no significant difference in door-to-balloon times, radiation dose or in-hospital length of stay between the RA and FA groups. In-hospital mortality rates were higher in FA group vs. RA group (6.8% vs. 2.0%, p=0.009). However, following the exclusion of cardiogenic shock patients, the in-hospital mortality rates were no different, 2.4% vs. 4.3%, (p=0.10). There was a higher rate of combined vascular complications in the FA group (1.4% vs. 0%, p=0.05). RA access was associated with a higher screening time (minutes) 9 (3 to 15) vs. 7.5 (0.5 to 14.5)(p<0.0001) and access site failure 2.8% vs. 0.1% (p<0.0001). Conclusion: Our data demonstrates that in patients without cardiogenic shock undergoing PPCI, there is no significant difference in outcomes for FA versus RA access.

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