Transradial vs Transfemoral Approach for PCI in Elderly
Transradial vs Transfemoral Approach for PCI in Elderly
From January 2008 to December 2011, a total of 283 consecutive STEMI patients older than 75 years of age underwent primary PCI at our institution. Of these, 177 were treated via TRA, while the remaining 106 were treated via TFA. No exclusion criteria were applied, except for those patients with planned TRA who required a cross-over to TFA. The analysis included patients with Killip class IV or cardiogenic shock at presentation. PCI was routinely performed with standard techniques via femoral or radial approach using 6 Fr right and left catheters. TFA was preferably used in cases of worst Killip classification at presentation using a 6 Fr sheath (Cordis); in TRA cases, the right radial artery was the preferred site, leaving the left radial artery only for patients with previous bypass graft (left internal mammary artery) and/or absence of right pulse; a 25-cm long hydrophilic sheath (Terumo) was inserted. Patients not preloaded with oral aspirin and/or clopidogrel received a loading dose of intravenous aspirin (500 mg) and clopidogrel (600 mg) as the standard practice in our catheterization laboratory. Intravenous heparin (70 UI/kg body weight) was administered before the procedure with subsequent boluses aiming at achieving an activating clotting time (ACT) between 250 and 300 seconds. The use of glycoprotein (GP) IIb/IIIa inhibitors was left to operator discretion. In case of bivalirudin administration, a 0.75 mg/kg bolus dose followed by a 1.75 mg/kg/hour intravenous infusion terminated immediately after the end of the procedure was administered. Demographic and procedural data, including door-to-balloon time, access time in catheterization laboratory, time of arterial puncture (defined as the interval between access in catheterization laboratory and the sheath introduction) and inflation of the balloon (as the interval between sheath introduction and guidewire crossing the culprit lesion) were recorded. The main outcome of interest was the time to dilatation. Postprocedural access-site "bleeding" was defined according to TIMI criteria and hematoma was defined as an arterial puncture site swelling ≥5 cm. Statistical analysis comparing the two groups, with Student's t-test for continuous variables and chi-square test for categorical variables was performed using SPSS 15.0 software package (SPSS Inc).
Methods
From January 2008 to December 2011, a total of 283 consecutive STEMI patients older than 75 years of age underwent primary PCI at our institution. Of these, 177 were treated via TRA, while the remaining 106 were treated via TFA. No exclusion criteria were applied, except for those patients with planned TRA who required a cross-over to TFA. The analysis included patients with Killip class IV or cardiogenic shock at presentation. PCI was routinely performed with standard techniques via femoral or radial approach using 6 Fr right and left catheters. TFA was preferably used in cases of worst Killip classification at presentation using a 6 Fr sheath (Cordis); in TRA cases, the right radial artery was the preferred site, leaving the left radial artery only for patients with previous bypass graft (left internal mammary artery) and/or absence of right pulse; a 25-cm long hydrophilic sheath (Terumo) was inserted. Patients not preloaded with oral aspirin and/or clopidogrel received a loading dose of intravenous aspirin (500 mg) and clopidogrel (600 mg) as the standard practice in our catheterization laboratory. Intravenous heparin (70 UI/kg body weight) was administered before the procedure with subsequent boluses aiming at achieving an activating clotting time (ACT) between 250 and 300 seconds. The use of glycoprotein (GP) IIb/IIIa inhibitors was left to operator discretion. In case of bivalirudin administration, a 0.75 mg/kg bolus dose followed by a 1.75 mg/kg/hour intravenous infusion terminated immediately after the end of the procedure was administered. Demographic and procedural data, including door-to-balloon time, access time in catheterization laboratory, time of arterial puncture (defined as the interval between access in catheterization laboratory and the sheath introduction) and inflation of the balloon (as the interval between sheath introduction and guidewire crossing the culprit lesion) were recorded. The main outcome of interest was the time to dilatation. Postprocedural access-site "bleeding" was defined according to TIMI criteria and hematoma was defined as an arterial puncture site swelling ≥5 cm. Statistical analysis comparing the two groups, with Student's t-test for continuous variables and chi-square test for categorical variables was performed using SPSS 15.0 software package (SPSS Inc).
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