Key result
Radial access linked to ~41% lower 30-day risk of major events vs femoral in STEMI.
Why the study?
The effectiveness of radial access in STEMI has been predominantly established in primary PCI with limited exploration in early postfibrinolytic patients undergoing a pharmacoinvasive strategy.
Does radial access improve 30-day clinical outcomes compared to femoral access in STEMI patients undergoing pharmacoinvasive or primary PCI strategies?
Cohort (n=1,820)
Does radial access improve 30-day clinical outcomes compared to femoral access in STEMI patients undergoing pharmacoinvasive or primary PCI strategies?
Odds Ratio: 0.59 (95% CI 0.44–0.78)
Absolute Event Rate: 8.9% vs 15.7%
p-value: p=<0.001
Radial access is associated with improved 30-day clinical outcomes compared to femoral access in STEMI patients, regardless of whether a pharmacoinvasive or primary PCI strategy is utilized.
Radial access was associated with fewer events than femoral regardless of strategy; extends prior data to pharmacoinvasive STEMI but leaves open randomized confirmation.
Background The effectiveness of radial access ( RA ) in ST ‐elevation myocardial infarction ( STEMI ) has been predominantly established in primary percutaneous coronary intervention ( pPCI ) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral ( FA ) access in STEMI undergoing either a pharmacoinvasive ( PI ) strategy or pPCI . Methods and Results Within ST rategic Reperfusion Early After Myocardial Infarction ( STREAM ), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site ( FA : PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ ST ‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients ( P <0.001). On multivariable analysis, this benefit on the primary composite outcome favoring RA persisted (adjusted odds ratio [ OR ], 0.59; 95% CI , 0.44–0.78; P <0.001) and was evident in both pPCI (adjusted OR , 0.63; 95% CI , 0.43–0.92) and PI cohorts (adjusted OR , 0.57 95% CI , 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group ( RA vs FA , 5.2% vs 6.0%; P =0.489). Conclusions Regardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI . Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00623623.
No takes yet. Share an insight, caveat, or question.
Shavadia et al. (2016) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=1,820). Radial access vs. Femoral access was evaluated on 30-day composite of death, shock, congestive heart failure, or reinfarction (adjusted OR 0.59, 95% CI 0.44-0.78, p=<0.001). Radial access was associated with a lower 30-day risk of death, shock, heart failure, or reinfarction compared to femoral access in STEMI patients (adjusted OR 0.59; 95% CI 0.44-0.78; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: