Vascular Closure Devices Attenuate Femoral Access Complications of Primary Percutaneous Coronary Intervention

Objectives. To compare severe complications related to radial access and those related to femoral access using vascular closure devices for patients undergoing primary percutaneous coronary intervention (PCI). Background. Femoral artery access is still used for acute myocardial infarction management; studies comparing state-of-the-art radial and femoral techniques are required to minimize bias regarding the outcomes associated with operator preferences. Methods. We performed a randomized study comparing radial access with a compression device and anatomic landmark-guided femoral access with a hemostatic vascular closure device. The severe complication rates related to the access site were assessed until hospital discharge. A meta-analysis including studies with comparable populations reporting severe bleeding and major adverse cardiovascular event rates was performed. Results. A total of 250 patients were included who underwent PCI between January 2016 and February 2019. Mean age was 61.5 +/- 12.2 years, 73.2% were men, and 28.4% had diabetes. There were no differences between groups or in vascular access-related severe complication rates [8.0% for femoral group vs 5.6% for radial group; P=.45]. Although radial access was associated with decreased vascular complications related to the access site when compared with the femoral approach [relative risk [RR], 0.64; 95% confidence interval [CI], 0.43-0.95], the meta-analysis did not show an impact on severe bleeding [RR, 0.74; 95% CI, 0.37-1.46] or severe cardiovascular adverse events [RR. 0.69; 95% CI, 0.30-1.58]. Conclusions. Compliance with femoral artery puncture techniques and routine use of a vascular closure device promoted low severe complication rates.