Key result
Transradial access for primary PCI in STEMI was associated with significantly lower 30-day MACE compared to transfemoral access (2.0% vs. 5.6%; OR 0.35; 95% CI 0.13-0.95; p=0.02).
Why the study?
Does a transradial approach reduce adverse clinical events and bleeding compared to a transfemoral approach in patients with STEMI undergoing primary PCI?
Observational (n=3,340)
Does a transradial approach reduce adverse clinical events and bleeding compared to a transfemoral approach in patients with STEMI undergoing primary PCI?
In patients with STEMI undergoing primary PCI, a transradial approach is associated with reduced major bleeding and improved event-free survival compared to a transfemoral approach.
Answers are grounded in this paper and cite their sources.
May favor transradial access in STEMI primary PCI; leaves open need for randomized confirmation before practice change.
AIMS: We sought to determine whether a transradial (TR) approach compared with a transfemoral (TF) approach was associated with improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in a post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data comparing the TR approach with the TF approach in patients with STEMI treated with primary PCI and contemporary anticoagulant regimens. METHODS AND RESULTS: In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340 patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints included the 30-day and one-year rates of major adverse cardiovascular events (MACE: death, reinfarction, stroke or target vessel revascularisation), non CABG-related major bleeding, and net adverse clinical events (NACE: MACE or major bleeding). TR compared to TF access was associated with significantly lower 30-day rates of composite death or reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95], p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year, the TR group still had significantly reduced rates of death or reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89], p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By multivariable analysis, TR access was an independent predictor of freedom from MACE and NACE at 30 days and one year. CONCLUSIONS: In patients with STEMI undergoing primary PCI with contemporary anticoagulation regimens in the HORIZONS-AMI trial, a TR compared with a TF approach was associated with reduced major bleeding and improved event-free survival.
No takes yet. Share an insight, caveat, or question.
Généreux et al. (2011) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=3,340). Transradial (TR) approach vs. Transfemoral (TF) approach was evaluated on 30-day major adverse cardiovascular events (MACE) (OR 0.35, 95% CI 0.13-0.95, p=0.02). Transradial access for primary PCI in STEMI was associated with significantly lower 30-day MACE compared to transfemoral access (2.0% vs. 5.6%; OR 0.35; 95% CI 0.13-0.95; p=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: