Comparative Efficacy and Safety of Radial vs. Femoral Access in Emergency Percutaneous Coronary Intervention: A Prospective Study at Hayatabad Medical Complex, Peshawar

Objectives: This study aims to compare the efficacy and safety of radial versus femoral access in patients undergoing emergency percutaneous coronary intervention (PCI) at Hayatabad Medical Complex, Peshawar, from August 2023 to July 2024. Methodology: A prospective, observational study was conducted involving 250 patients with acute coronary syndrome (ACS) undergoing emergency PCI. Of these, 175 patients received radial access and 75 received femoral access. Data were collected on patient demographics, procedural characteristics, and clinical outcomes, with primary outcomes focusing on complication rates, mortality, and major adverse cardiovascular events (MACE). Statistical analysis included Chi-square and t-tests, with multivariate regression used to identify independent predictors of complications and mortality. Results: A total of 250 patients participated in the study, with 175 (70%) receiving radial access and 75 (30%) undergoing femoral access. Radial access was associated with a significantly lower complication rate (14%) compared to femoral access (30%), with a p-value of < 0.01. Procedure durations were similar between the two groups, with an average of 45.8 +/- 9.6 minutes for radial access and 47.1 +/- 10.3 minutes for femoral access. Fluoroscopy times were also comparable. In-hospital mortality was lower in the radial group (3%) than in the femoral group (7%), though this difference did not reach statistical significance (p = 0.12). MACE rates were similar between the two groups, with no statistically significant differences (p = 0.58). Conclusion: Radial access demonstrated a significantly lower complication rate compared to femoral access, making it a safer alternative for emergency PCI. These findings suggest that radial access should be considered the preferred approach for emergency PCI, especially in resource-limited settings like Pakistan, where minimizing complications and improving recovery times are crucial for enhancing healthcare outcomes and operational efficiency.