Comparison of Access Site Complications in Primary Percutaneous Coronary Intervention (PCI) Using the Radial Versus the Femoral Approach for Complex Lesions: A Prospective Study

Percutaneous coronary intervention (PCI) is a widely used therapeutic approach for complex coronary artery disease, especially in patients with ST-elevation myocardial infarction (STEMI). The choice of vascular access site, typically radial or femoral, can significantly impact patient outcomes due to varying complication rates associated with each approach. This study aimed to compare access site complications between radial and femoral approaches in primary PCI for complex coronary lesions, providing insights into the safety and efficacy of these approaches. A prospective cohort study was conducted from January 1, 2023, to December 31, 2023, at a tertiary care cardiovascular center. A total of 350 adult patients presenting with STEMI and requiring emergency PCI for complex coronary lesions were included and randomized equally to either radial (n = 175) or femoral (n = 175) access groups. Primary outcomes included access site complications, such as hematomas, pseudoaneurysms, arteriovenous fistulas, and major bleeding events. Secondary outcomes included procedural success, access site crossover, and hospital stay duration. Data were analyzed using chi-square tests, Student's t-tests, and multivariate logistic regression. The incidence of access site complications was significantly lower in the radial group (11.4%) compared to the femoral group (22.9%) (p = 0.007). Major bleeding events were also notably reduced in the radial group (2.3% vs. 8.6%, p = 0.01). There was a significantly shorter median hospital stay for the radial group (three days vs. five days, p < 0.001), while procedural success rates were comparable between groups (97.1% vs. 94.3%, p = 0.31). The radial approach for primary PCI in complex lesions is associated with fewer access site complications and shorter hospital stays compared to the femoral approach, supporting its use as the preferred access site.