IJCS | Volume 31, Nº6, November / December 2018

DOI: 10.5935/2359-4802.20180066 562 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(6)562-568 Mailing Address: Luís Cláudio Lemos Correia Av. Princesa Leopoldina, 19/402. Postal Code: 40150-080, Graça, Salvador, BA - Brazil. E-mail: lccorreia@cardiol.br , lccorreia@terra.com.br Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox Yasmin Falcon Lacerda, 1 Nicole Cruz de Sá, 1 Jessica Gonzalez Suerdieck, 1 Letícia Fonseca, 1 Fernanda Lopes, 1 Gabriella Sant'Ana Sodré, 1 Mateus dos Santos Viana, 1 Marcia Maria Noya Rabelo, 2 Luis Claudio Lemos Correia 1,2 Escola Bahiana de Medicina e Saúde Pública, 1 Salvador, BA - Brazil Hospital São Rafael, Fundação Monte Tabor, 2 Salvador, BA - Brazil Manuscript received November 07, 2017, revised manuscript April 26, 2018, accepted May 03, 2018. Abstract Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05. Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access – age (OR = 0.98; 95%CI = 0.96 – 0.99), creatinine (OR = 0.54; 95%CI = 0.3 – 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 – 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 – 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018;31(6)562-568) Keywords: Angioplasty; Catheterism; Coronary Artery Disease; Percutaneous Coronary Intervention; Radial Artery; Femoral Artery; Stents. Introduction Percutaneous coronary intervention (PCI) is the main revascularization procedure performed in acute coronary syndromes (ACS) due to its efficacy in preventing recurrent coronary events and less invasiveness as compared with surgical procedures. 1 However, PCI is not free of complications, with access site bleeding as the most common adverse effect. 2 Femoral access has been the predominant site for PCI for decades, due to its relative feasibility to perform. Radial access, in turn, has shown to be efficient in preventing bleeding and therefore has become the preferred procedure in the last years. 2-5 The radial approach, however, is a more complex technique, requiring greater technical ability and experience. 6 Thus, considering the higher feasibility and reproducibility of the femoral access and the lower risk of bleeding of the radial access, both techniques are available for PCI. Efficacy is the intrinsic property of the treatment, described in the ideal world of clinical trials, in which intervention occurs in a random fashion, excluding