Radial Versus Femoral Access With or Without Vascular Closure Device in Patients With Acute Myocardial Infarction
- Author(s)
- Namkyun Kim; Jang Hoon Lee; Se Yong Jang; Myung Hwan Bae; Dong Heon Yang; Hun Sik Park; Yongkeun Cho; Jae Yong Yoon; Myung Ho Jeong; Jong-Seon Park; Hyo-Soo Kim; Seung-Ho Hur; In-Whan Seong; Myeong-Chan Cho; Chong-Jin Kim; Shung Chull Chae
- Keimyung Author(s)
- Hur, Seung Ho
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- American Journal of Cardiology
- Issued Date
- 2019
- Volume
- 123
- Issue
- 5
- Abstract
- Compared with transradial intervention (TRI), it is unclear whether transfemoral intervention (TFI) with vascular closure device (VCD) improves major adverse cardiocerebrovascular events (MACCE) in patients with acute myocardial infarction (AMI). The aim of this study is to compare TRI versus TFI with or without VCD for reducingMACCEs. We examined 11,596 patients who underwent TRI or TFI from the Korean AMI Registry − National Institute of Health database. The MACCE at 1-year was defined as death, nonfatal MI, repeat revascularization, cerebrovascular accident, hospitalizations, and major bleedings. Because the patients were not randomly assigned to vascular access sites, propensity-score (PS) matching was performed. In the PS-matched cohorts, compared with TFI, TRI significantly reduced 1-year MACCEs (7.1% vs 10.1%; log-rank p < 0.001) through a reduction in major bleeding (0.6% vs 2.2%; p < 0.001). Compared with TRI, 1-year MACCEs (11.3% vs 7.9%, log-rank p < 0.001) and major bleedings (0.6% vs 2.2%; p < 0.001) were significantly greater in TFI without VCD, whereas TFI with VCD was comparable in 1-year MACCEs (7.5% vs 8.1%, log-rank p = 0.437) and major bleeding (0.7% vs 1.0%; p = 0.409). In conclusion, the use of VCD could be an alternative to avoid major bleeding and to improve clinical outcomes, particularly in high-risk patients who are not suitable for TRI.
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