TRANSRADIAL VERSUS TRANSFEMORAL PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROMES: AN OBSERVATIONAL STUDY OF BLEEDING, VASCULAR COMPLICATIONS, CONTRAST USE AND IN-HOSPITAL OUTCOMES

Abstract

Background: Vascular access is an important determinant of bleeding and procedural complications during percutaneous coronary intervention (PCI), particularly in patients with acute coronary syndromes (ACS) receiving intensive antithrombotic therapy. Transradial access has increasingly become the preferred access strategy in contemporary ACS practice, although transfemoral access remains important in selected patients and in centers with variable radial expertise. Randomized trials and meta-analyses have consistently demonstrated reductions in access-site bleeding and vascular complications with radial access, while differences in ischemic outcomes have varied according to ACS phenotype, operator experience and study population.
Objective: To compare transradial and transfemoral PCI in patients with ACS with respect to contrast volume, bleeding, vascular complications, procedural characteristics and in-hospital clinical outcomes.
Methods: This retrospective observational study included 150 consecutive patients with ACS undergoing PCI. Patients were categorized according to initial arterial access: radial (n=105) or femoral (n=45). Baseline characteristics, procedural variables, contrast volume, bleeding events, access-site complications, acute kidney injury, length of stay and in-hospital major adverse cardiovascular events (MACE) were compared. Bleeding was classified according to clinically relevant categories informed by Bleeding Academic Research Consortium definitions.
Results: Mean contrast volume was lower in the radial group than in the femoral group (153.3±35.1 vs 177.2±45.8 mL; simulated P<0.001). Major bleeding occurred in 2.9% versus 15.6% (P=0.008), hematoma in 11.4% versus 35.6% (P=0.001), vascular complications in 1.9% versus 11.1% (P=0.026), and blood transfusion in 1.9% versus 11.1% (P=0.026), respectively. Contrast-associated acute kidney injury occurred in 7.6% versus 11.1% (P=0.53). In-hospital MACE occurred in 7.6% of radial-access patients and 17.8% of femoral-access patients (P=0.084). Median/mean hospital stay was shorter with radial access (3.8±1.1 vs 4.4±1.4 days; P=0.01).
Conclusion: In this ACS cohort, radial access was associated with fewer bleeding and access-site complications and lower contrast use, while differences in MACE and mortality were not statistically conclusive. These findings are directionally consistent with the established randomized and meta-analytic evidence supporting radial access in ACS.