Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

- This study aimed to evaluate the safety and efficacy of the TR approach and compare them to those of the TF approach in PCI in octogenarian patients with acute MI.
- The TR approach was used for PCI in 17% of the octogenarians in our study population (comparable to the 20% of patients among all patients in the registry).
- We found that the TR approach for treating acute MI is safe and effective even for octogenarians.
- In addition, the propensity-matched analysis showed that the TR approach is significant predictor of a low in-hospital mortality rate.

BackgroundThe transradial (TR) approach for percutaneous coronary intervention (PCI) is challenging and associated with failure in elderly patients. We compared the TR and transfemoral (TF) approaches in patients > 80 years with acute myocardial infarction (MI) undergoing PCI.MethodsA total of 1945 (7.2%) octogenarians were enrolled from among 27,129 patients in the Korea Acute Myocardial Infarction Registry. The TR group (n = 336, 17.3%) was compared with the TF group (n = 1609, 82.7%) in the overall and propensity-matched cohorts with respect to procedural success, complications, in-hospital mortality, and one-year mortality and total major adverse cardiac event (MACE; death, MI, and revascularization) rate.ResultsIn the overall cohort, the TR group had lower incidence of Killip class III or IV compared to the TF group. The disease extent and lesion severity were similar between groups, as was the procedural success rate (97.7% vs. 98.3%); however, in-hospital complications were significantly lower in the TR group (8.1% vs. 20.3%). In-hospital mortality was significantly lower in the TR group than the TF group (3.4% vs. 11.4%), as were the one-year mortality and total MACE (9.8% vs. 18.4% and 13% vs. 21.9%, respectively). These outcomes were consistent in the propensity-matched cohort. The TR approach was found to be a significant predictor of low in-hospital mortality (OR 0.355, 95% CI 0.139-0.907), but not of one-year mortality (OR 0.644, 95% CI 0.334-1.240).ConclusionsIn octogenarians with acute MI undergoing PCI, the TR approach was more effective than the TF approach as it had lower complication rate and better clinical outcomes with comparable procedural success.