NDLI: Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.

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Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.

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Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rathod, Krishnaraj S. Jones, Daniel A. Bromage, Daniel I. Gallagher, Sean M. Rathod, Vrijraj S. Kennon, Simon Knight, Charles Rothman, Martin T. Mathur, Anthony Smith, Elliot Jain, Ajay K. Archbold, R. Andrew Wragg, Andrew
Spatial Coverage	England
Description	Country affiliation: United kingdom Author Affiliation: Rathod KS ( aDepartment of Cardiology, London Chest Hospital bDepartment of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University cNIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.)
Abstract	AIM: To compare long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) using radial and femoral arterial access. METHODS AND RESULTS: The present study was an observational cohort study of patients with STEMI treated consecutively with PPCI between 2004 and 2011 at a single centre. The primary end point was all-cause mortality at a median follow-up of 3 years.Among 2727 patients, 1600 (58.7%) underwent PPCI via the femoral route. The femoral group was older (64.7 vs. 61.7 years; Pâ<â0.0001), and had higher rates of diabetes (18.6% vs. 16.0%; Pâ<â0.0001), previous PCI (11.2 vs. 7.8%; Pâ=â0.004), previous myocardial infarction (15.3 vs. 8.3%; Pâ<â0.0001) and cardiogenic shock (9.8 vs. 1.3%; Pâ<â0.0001). Bleeding complications were more frequent in the femoral group (4.7 vs. 1.2%; Pâ<â0.0001). The 5-year death rate was significantly higher in the femoral group than in the radial group (10.4 vs. 3.0%; Pâ<â0.0001). After adjustment for confounding variables, bleeding complications [heart rate 2.07 (95% confidence interval 1.05-4.08)] and femoral access [heart rate 1.60 (95% confidence interval 1.02-2.53)] were independent predictors of all-cause mortality. After stratification using the propensity score, excess long-term mortality in patients treated via the femoral approach was predominantly in patients with a high baseline risk of death. CONCLUSION: Patients undergoing PPCI via the femoral route are at a higher risk of adverse short-term and long-term outcomes than patients undergoing PPCI via the radial route. Patients with a high baseline risk may benefit most from radial access, and future outcome studies should focus on the most at-risk patients.
File Format	HTM / HTML
ISSN	15582027
Issue Number	3
Volume Number	16
e-ISSN	15582035
Journal	Journal of Cardiovascular Medicine
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2015-03-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Discipline Vascular Diseases Femoral Artery Surgery Myocardial Infarction Mortality Percutaneous Coronary Intervention Methods Radial Artery Aged Aged, 80 And Over Cohort Studies England Epidemiology Female Humans Male Middle Aged Statistics & Numerical Data Treatment Outcome Journal Article Observational Study
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine

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Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.

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Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients.