Predictors of radial to femoral artery access crossover during primary percutaneous coronary intervention for ST-elevation myocardial infarction

Journal article


Dang, Denee, Kuhn, Lisa, Fooladi, Ensieh, Ky, Vivian, Cheung, Kevin, Rashid, Hashrul and Zaman, Sarah. (2022). Predictors of radial to femoral artery access crossover during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Heart, Lung and Circulation. 31(7), pp. 985-992. https://doi.org/10.1016/j.hlc.2022.01.016
AuthorsDang, Denee, Kuhn, Lisa, Fooladi, Ensieh, Ky, Vivian, Cheung, Kevin, Rashid, Hashrul and Zaman, Sarah
Abstract

Background
Radial access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding, when compared to femoral access. However, radial access failure may be associated with an increased door-to-device (DTD) time.

Aims
To identify predictors of radial access failure requiring crossover to femoral artery access during primary PCI.

Methods
From 2013 to 2020, 2,256 consecutive patients treated for PPCI at a single tertiary hospital were prospectively recruited into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariable logistic regression was used to identify independent predictors of radial to femoral access crossover.

Results
From 2,256 STEMI patients, primary radial access was used in 1,778 (78.8%), with 171 (9.6%) experiencing radial-to-femoral crossover. Patients with failed versus successful radial access experienced longer DTD times (67 mins, interquartile range [IQR] 46–99 vs 54 mins [IQR 39-78]; p<0.001). Independent predictors of radial-to-femoral access crossover included female sex (Adjusted Odds Ratio [AOR] 2.1, 95% Confidence Interval [CI] 1.4–3.0; p<0.001) and baseline hypertension (AOR 1.5, 95% CI 1.1–2.1; p=0.018).

Conclusion
In a real-world STEMI registry, almost 1 in 10 patients experienced access crossover from the radial to femoral artery which resulted in longer DTD times. Independent predictors of radial access failure included female sex and baseline hypertension. Knowing which patient characteristics are associated with increased risk of radial artery failure enables catheter laboratory staff to ensure equipment is readily available to maximise successful primary PCI are available.

Keywordsangiography; crossover; femoral artery; primary percutaneous coronary intervention; radial artery; ST elevation myocardial infarction
Year2022
JournalHeart, Lung and Circulation
Journal citation31 (7), pp. 985-992
PublisherElsevier B.V.
ISSN1443-9506
Digital Object Identifier (DOI)https://doi.org/10.1016/j.hlc.2022.01.016
PubMed ID35304061
Scopus EID2-s2.0-85126541860
Page range985-992
FunderAbbott Vascular
Biotronik Australia
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online15 Mar 2022
Publication process dates
Accepted26 Jan 2022
Deposited05 Jul 2023
Place of publicationUnited Kingdom
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