Radial versus femoral access in ST-elevation myocardial infarction complicated by out of hospital cardiac arrest

Out of hospital cardiac arrest (OHCA) is the most concerning complication of ST-elevation myocardial infarction (STEMI) and is associated with a poor prognosis. Immediate coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) are recommended to restore myocardial perfusion. However, there is limited data on the preferred vascular access for these patients, who are at higher risk of both hemorrhagic and thrombotic events. We sought to evaluate the impact of radial as compared to femoral access in the population of OHCA patients with STEMI. This observational, single-center study prospectively included consecutive patients diagnosed with STEMI complicated by OHCA who were admitted to the catheterization laboratory between January 2007 and December 2022. The primary endpoint was a composite of in-hospital death from any cause and/or bleeding of any type and/or stent thrombosis. Propensity score matching was performed to further adjust for potential confounders. Our study included 311 patients with a mean age of 59.0 year, of whom 77.5% were male. The primary endpoint occurred in 184 patients. Femoral access was independently associated with a higher risk of the primary endpoint compared to the radial access, both in univariate (OR=2.36; 95% CI [1.38-4.08]; p=0.01) and multivariate analysis (OR=2.25; 95% CI [1.05-4.91]; p=0.04). Consistent results were observed after propensity score matching (OR=1.97; 95% CI [1.09-3.58], p=0.03). In our analysis, femoral access was associated with a higher incidence of the primary composite outcome compared to radial access, in patients with STEMI complicated by OHCA undergoing emergent CAG.