Clinical Outcomes of Radial Versus Femoral Access for Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Retrospective Study From Southern Puerto Rico

Background and aimPatients with ST-segment elevation myocardial infarction (STEMI) frequently undergo percutaneous coronary intervention (PCI) using either radial or femoral arterial access.Prior studies have shown potential benefits of radial access; however, data are limited regarding these approaches in patients from Puerto Rico.This study aimed to compare bleeding, vascular complications, and 30-day all-cause mortality between radial and femoral access for PCI in patients with STEMI in southern Puerto Rico. MethodsWe conducted a cross-sectional review of medical records of patients aged 21-90 years admitted with STEMI at Centro Médico Episcopal San Lucas in southern Puerto Rico from 2021 to 2023.We excluded patients with non-ST-segment elevation myocardial infarction or unstable angina.A total of 311 patients were identified and included in the study.Patients were stratified according to radial or femoral access on the first attempt.Outcomes included 30-day all-cause mortality, pseudoaneurysm, hematoma, and bleeding after thrombolysis in myocardial infarction.All statistical analyses were conducted using RStudio (Boston, MA: Posit, PBC). ResultsAmong the study subjects, 90 patients had first-attempt radial access, while 221 patients had first-attempt femoral access.There were no major bleeding events in any of the groups.Minor bleeding events were reported for one out of 90 patients in the radial group compared to 21 patients out of 221 in the femoral group.This difference was statistically significant (p=0.01791).Pseudoaneurysm did not occur in the radial group, while seven occurred in the femoral group; however, this difference was not statistically significant.No hematoma was seen in any patient in the first-attempt radial access group, compared with 33 patients with hematoma in the femoral access group (p=0.001).Mortality within 30 days from all causes occurred in one of 90 patients in the radial group compared with 26 of 221 patients in the femoral group.The 30-day survival rate was 98.9% in the radial group and 88.2% in the femoral group, representing a statistically significant difference (p=0.0012). ConclusionAmong patients with STEMI undergoing PCI in southern Puerto Rico, first-attempt radial access was associated with lower rates of minor bleeding, hematoma, and 30-day all-cause mortality compared with first-attempt femoral access.The results suggest potential clinical advantages of radial access when clinically appropriate.However, since the current study is of an observational design, it is not reasonable to claim a cause-and-effect relationship.Larger studies that control for clinical factors are needed.