Results of Primary Percutaneous Coronary Intervention in Patients ≥75 Years Treated by the Transradial Approach

• Published in: The American journal of cardiology 2014-02, Vol.113 (3), p.452-456
• Main Authors: Rodriguez-Leor, Oriol, MD, Fernandez-Nofrerias, Eduard, MD, Carrillo, Xavier, MD, Mauri, Josepa, MD, PhD, Labata, Carlos, MD, Oliete, Carolina, RN, Rivas, Maria del Carmen, RN, Bayes-Genis, Antoni, MD, PhD
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Blood pressure; Cardiac Catheterization - methods; Cardiology; Cardiovascular; Coronary vessels; Female; Follow-Up Studies; Gender; Heart attacks; Hospital Mortality - trends; Hospitalization; Humans; Male; Mortality; Multivariate analysis; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Percutaneous Coronary Intervention - methods; Prospective Studies; Radial Artery; Regression analysis; Spain - epidemiology; Stroke; Treatment Outcome; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.10.030

Previous trials in elderly patients with ST-elevation myocardial infarction (STEMI) have not shown a definitive benefit of primary percutaneous coronary intervention (PPCI) by transfemoral approach over thrombolysis. The transradial approach (TRA) is associated with a significant decrease in mortality, MACE (Major Adverse Cardiac Event), and serious access site complications compared with the transfemoral approach. We have evaluated clinical outcomes in a cohort of real-life unselected ≥75-year-old patients with STEMI treated by TRA-PPCI. This is a single-center prospective, observational registry of consecutive patients with STEMI who underwent PPCI between February 2007 and February 2013. MACE was defined as death, reinfarction, or stroke. A total of 307 patients were treated by PPCI, 293 (95.1%) with TRA-PPCI (mean age 80 ± 2 years, 42% women). Patients had high co-morbidity levels (cardiogenic shock on admission 8.5%, previous myocardial infarction 11.6%, diabetes 30.4%, previous renal failure 25.6%, previous PCI 9.6%, and peripheral arterial disease 14.3%); IIbIIIa inhibitors were used in 45.1% of patients. Severe bleeding and need for transfusion were recorded for 6.5% and 9.9% of patients, respectively. In-hospital mortality, 1-year mortality, and 1-year MACE were 11.9%, 17.4%, and 22.2%, respectively. Excluding 25 patients with cardiogenic shock on admission, the in-hospital mortality, 1-year mortality, and 1-year MACE were 7.8%, 13.1%, and 17.9%, respectively. In conclusion, TRA-PPCI was feasible in the vast majority of elderly patients with STEMI. In-hospital mortality, 1-year mortality, and 1-year MACE were lower than reported for transfemoral access, suggesting a benefit of the TRA in these patients.