Clinical outcomes between transradial and transfemoral primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction in Chonburi Hospital

Artit  Torpongpun; Pornchai  Ngamjanyaporn; Woravit  Tantisiriwat; Chanadda  Rutnuntamongkon; Gahn  Nakornchai; Paramaporn  Suttirut

Authors

Artit Torpongpun Chonburi Hospital, Chonburi, Thailand
Pornchai Ngamjanyaporn Chonburi Hospital, Chonburi, Thailand
Woravit Tantisiriwat Chonburi Hospital, Chonburi, Thailand
Chanadda Rutnuntamongkon Chonburi Hospital, Chonburi, Thailand
Gahn Nakornchai Chonburi Hospital, Chonburi, Thailand
Paramaporn Suttirut Chonburi Hospital, Chonburi, Thailand

Keywords:

Primary percutaneous coronary intervention and ST-segment elevation myocardial infarction, transfemoral, transradial

Abstract

Background: Recent global data have shown that transradial primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) yields better procedural outcomes than transfemoral PCI.

Objective: This study compared clinical outcomes between the transradial approach (TRA) and the transfemoral approach (TFA) in primary PCI for patients with STEMI at Chonburi Hospital.

Methods: This retrospective study enrolled 913 patients with STEMI who underwent primary PCI at Chonburi Hospital between October 1, 2016, and September 30, 2023. Clinical data were extracted from medical records and the hospital’s STEMI registry.

Results: Of the 913 patients with STEMI, 532 underwent TRA and 381 underwent TFA. The TRA group was significantly younger (58.3 ± 12.2 vs. 64.0 ± 14.0 years) and predominantly male (81.2% vs. 68.5%). The TFA group had a higher rate of diabetes (35.7% vs. 27.6%), cardiac arrest (19.7% vs. 11.1%), and Killip class IV (24.2% vs. 9.7%). The mean left ventricular ejection fraction was higher in the TRA group (50.3% vs. 47.1%), while infarct locations (anterior/inferior) were similar. TRA was associated with significantly better outcomes than TFA, including lower all-cause mortality (2.1% vs. 12.9%), major bleeding (0.4% vs. 1.6%), hemorrhagic stroke (0.0% vs. 0.8%), and shorter mean length of stay (3.0 vs. 4.1 days). Multivariate regression analysis identified Killip class (odds ratio (OR) 3.15; 95% confidence interval (CI) 2.21–4.49), cardiac arrest (OR 2.65; 95% CI 1.18–5.95), and age (OR 1.05; 95% CI 1.02–1.09) as predictors of mortality, while the TRA was independently associated with reduced mortality (OR 0.37; 95% CI 0.12–0.93).

Conclusion: In this study, the TRA was associated with significantly reduced all-cause mortality, major bleeding events, and hospital length of stay compared to the TFA, thereby confirming its benefit in patients with STEMI undergoing primary PCI.

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