Clinical Outcomes and Associations With Radial to Femoral Crossover in ST-Elevation Myocardial Infarction

Christopher Balfe, Benjamin Jacob, Samir Morad, Amged Elsayed, Lok Yi Joyce Tan, Edel Nelson, Ali AlBaghdadi, Aoife Power, David Twomey, Breda McDermott, Catriona Ahern, Syed Farhat Abbas, Terence Hennessy, Ihsan Ullah, Samer Arnous, Thomas Kiernan

Research output: Contribution to journalArticlepeer-review

Abstract

Radial access during primary percutaneous coronary intervention is associated with reduced mortality and major bleeding compared with femoral access and is the recommended access site. Nevertheless, failure to secure radial access may necessitate crossover to femoral access. This study aimed to identify the associations with crossover from radial to femoral access in all comers with ST-elevation myocardial infarction and to compare the clinical outcomes with those patients who did not require crossover. From 2016 to 2021, a total of 1,202 patients presented to our institute with ST-elevation myocardial infarction. Associations, clinical outcomes, and independent predictors of crossover from radial to femoral access were identified. From 1,202 patients, radial access was used in 1,138 patients (94.7%) and crossover to femoral access occurred in 64 patients (5.3%). Patients who required crossover to femoral access had higher rates of access site complications and longer length of stay in the hospital. Inpatient mortality was higher in the group requiring a crossover. This study identified 3 independent predictors of crossover from radial to femoral access in primary percutaneous coronary intervention: cardiogenic shock, cardiac arrest before arrival at the catheterization laboratory, and previous coronary artery bypass grafting. Biochemical infarct size and peak creatinine was also found to be higher in those requiring crossover. In conclusion, crossover in this study portended an increased rate of access site complications, greatly prolonged length of stay, and a significantly higher risk of death.

Original languageEnglish
Pages (from-to)103-111
Number of pages9
JournalAmerican Journal of Cardiology
Volume200
DOIs
Publication statusPublished - 1 Aug 2023
Externally publishedYes

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