LAUSR

BACKGROUND Radial artery became preferable access for percutaneous coronary interventions (PCI). Latest European Society of Cardiology guidelines strongly recommended transradial access in ST-segment-elevation myocardial infarction (STEMI) patients. Though, in a significant portion of coronary artery invasive procedures crossover to femoral is necessary. AIMS To determine the ratio, risk factors and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry. METHODS Based on Polish registry ORPKI data we analyzed 90245 patients with diagnosis of STEMI that were intended to be treated invasively via trans radial access between 2014 and 2019. RESULTS In 1484 (1.6 %) individuals a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were: female gender, previous coronary artery by-pass graft, class 3 and 4 of Killip scale, left main disease as well as any complications during coronary angiography. In that cohort the risk of bleeding at the puncture site was over 20-fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, TIMI after PCI and no-reflow) between these groups resulted from disparities in initial characteristics and they were no associated with crossover itself. CONCLUSIONS Even though the risk of crossover to femoral is currently low it appears to be indispensable to sustain the operators proficiency both in radial and femoral approach to achieve the best outcomes in these patients.