Though on the Rise, the Transradial Approach to Primary PCI Remains Underused

There is evidence to support the use of the transradial approach to coronary angioplasty. Several randomized studies have shown reduced bleeding and vascular complications when adopted, compared against patients treated with the femoral approach. There are also studies and meta-analysis suggesting that, in the context of primary PCI, the benefit would be even bigger, with significant events rate reduction (even mortality rate).

This study aims at defining the different patient, operator and institution factors that may or may not contribute to adopting the transradial approach.

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The NCDR CathPCI registry included 692,433 patients undergoing primary PCI between 2009 and 2015. Only 12% of these patients (n=82,618) were treated via transracial access site.

Even though there are geographical differences, the use of the transradial approach has been increasing, going from 2% in 2009 to 23% in 2015,

Age, sex, cardiogenic shock, prior MI, operators starting before 2012, and non-academic institutions, are the factors tilting the scales for the femoral approach.

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When operators choose the transradial access site, there is significant reduction in bleeding, and when institutions adopt it, there is also mortality reduction.

Conclusion

Although the transradial approach to primary PCI is growing, it remains largely underused. 

Editorial Comment

The present analysis suggests that the evidence in favor of the transradial approach has had a positive impact in use, with a close to ten-fold increase in the last 6 years. However, in the US, figures are far lower than those reported by most European countries. Whether or not Latin America is adopting the transradial approach remains unclear, though intuitively, we should follow our European colleagues.

Título original: Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction. Insights from the NCDR CathPCI Registry.

Reference: Javier A. Valle et al. J Am Coll Cardiol Intv 2017. Article in press.

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