Transradial percutaneous coronary intervention in patients with acute coronary syndromes
Percutaneous coronary intervention (PCI), either performed as a primary intervention for ST-segment elevation myocardial infarction (STEMI) or as part of an early invasive strategy for high-risk non-STEMI, in combination with pharmacological advances has led to reduced rates of ischemic events and mortality in patients with ACS. In the setting of potent antithrombotic regimens and arteriotomy, major bleeding has been identified as a major contributor to cardiovascular events and death. Compared with transfemoral vascular access, transradial access has been shown to significantly reduce access-site complications that could potentially translate into reductions in the rates of major bleeding and ischemic events. Despite this, the uptake of transradial vascular access has been hindered as a consequence of the limited training of operators in this technique as well as concerns regarding access-site crossover, technical difficulty, procedural failure, and delayed reperfusion times. In this article, current evidence on the impact of bleeding in patients with ACS and the role of transradial PCI in improving outcomes in patients with ACS who are managed invasively is reviewed. Copyright Remedica Medical Education and Publishing.