Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry

Recent randomized clinical trials demonstrated that transradial approach was a preferred approach for primary percutaneous coronary intervention (PCI) in ST-elevation acute myocardial infarction (STEMI). However, clinical outcomes of transradial approach in STEMI have not been adequately evaluated yet in the real-world practice, which includes hemodynamically unstable high-risk patients. We identified 3662 STEMI patients who had primary PCI within 24 h after symptom onset and were treated by transradial (N = 471) or transfemoral (N = 3191) approach in the CREDO-Kyoto AMI registry. In the current analysis, we compared clinical characteristics and long-term outcomes between the 2 groups of patients treated by transradial approach and transfemoral approach. The prevalence of hemodynamically compromised patients (Killip II–IV) was significantly less in the transradial group than in the transfemoral group (19 vs. 25%, P = 0.002). Cumulative 5-year incidences of death/MI/stroke, and major bleeding were not significantly different between the transradial and transfemoral groups (26.7 vs. 25.9%, log-rank P = 0.91, and 11.3 vs. 11.5%, log-rank P = 0.71, respectively). After adjustment for confounders, the risks of the transradial group relative to the transfemoral group were not significant for both death/MI/stroke [Hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.83–1.59, P = 0.41] and major bleeding (HR 1.29, 95% CI 0.77–2.15, P = 0.34). In the subgroup of hemodynamically compromised patients, there were also no significant differences in the risks for death/MI/stroke and major bleeding between the 2 groups. Clinical outcomes of transradial approach were not different from those of transfemoral approach in primary PCI for STEMI in the real-world practice.