Thirty-Day Survival Rates Equivalent for Radial and Femoral Access in PCI Procedures
March 26, 2019—The American College of Cardiology (ACC) announced the presentation of data that indicates radial and femoral approaches to percutaneous coronary intervention (PCI) are equivalent in terms of the risk of death at 30 days. The data were presented by lead author Michel Le May, MD, at the ACC's 68th Annual Scientific Session, held March 16–18 in New Orleans, Louisiana.
According to the ACC, the study intended to enroll nearly 5,000 patients at five medical centers across Canada but stopped after enrolling 2,292. Within the study, all patients underwent PCI after ST-elevation myocardial infarction (STEMI); half were randomized to radial and half to femoral access.
An early analysis of the data revealed that it would not be possible to achieve the primary endpoint of a 1.5% difference in 30-day mortality between the two access types. Survival rates between radial and femoral approaches were similar at 1.5% and 1.3%, respectively, reported the ACC.
Dr. Le May commented in the ACC’s announcement, “Based on these findings, we feel you can achieve similar results with either approach if you have an efficient system for getting patients into the procedure quickly and a good team to perform it.” Dr. May is also the Director of the STEMI program at the University of Ottawa Heart Institute, in Ottawa, Ontario, Canada.
“We believe it is important for interventionists to be familiar with both radial and femoral access in order to be able to shift gears from one strategy to the other without hesitation," Dr. Le May continued. "I think it will be important for medical training programs to emphasize the need to be proficient at both the radial and femoral access. It is possible to become deskilled at doing one of the procedures, and a consistent emphasis on one approach over the other can lead to an increase in complications.”
Additional outcome data on subsequent heart attack, blood clotting at the stent, and bleeding complications were not significantly different between either group. In the ACC announcement, it was noted that patients without STEMI, or certain STEMI patient subgroups, may see different benefits from the two approaches, but additional data is necessary.
The study received funding from the Canadian Institutes of Health Research.