Howard Lan
Loma Linda University Medical Center, USA
Title: Clinical factors impacting access site in patients presenting with ST elevation myocardial infarction
Biography
Biography: Howard Lan
Abstract
Background: Despite, numerous publications showing improved outcomes in transradial (TR) access over transfemoral (TF) access in ST elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), clinical factors including age, body mass index (BMI), hemodynamics, bradyarrhythmias may impact management decisions in cath lab thus are important to take into consideration during initial evaluation as access site choice for each STEMI patient should be individualized for best overall outcome.
Objective: The objective of this study was to identify clinical factors that influence TR vs TF access site choice in STEMI patients undergoing angiography and PCI.
Methods: This is a single-center retrospective study of consecutive STEMI patients undergoing angiography and PCI between 2008-2012. 321 patients were enrolled. 294 patients underwent PCI via TF approach and 27 patients underwent PCI via TR approach.
Results: In logistic regression model, patient weight (HR 1.012–1.042, p<0.001) and body mass index (BMI) (HR 1.059-1.173, p<0.001) were the only significant factors favoring TR over TF approach in STEMI PCI. Other initial presenting factors such as age, gender, heart rate, and hypotension did not influence access site choice.
Conclusions: Current study suggests that STEMI patients with higher BMI, who are at increased risk for bleeding complications, are more likely to undergo PCI via TR over TF approach. Interestingly, the obesity paradox suggests that higher BMI is cardioprotective in acute coronary syndrome. The association among access site, BMI and mortality rate in STEMI PCI should be further investigated to delineate factors which result in better outcomes in STEMI patients.
Table.1: Baseline characteristics of ST elevation myocardial infarction patients who underwent percutaneous coronary intervention via transfemoral and transradial access. Hazard ratio and p-value were generated by logistic regression model demonstrating a statistical significant trend towards transradial approach in patients with higher weight and body mass index.