Key result
Radial access cuts major bleeding and access complications ~81% vs femoral access in STEMI.
Why the study?
The exact clinical benefit of the radial compared to the femoral approach in STEMI patients undergoing primary PCI remains controversial.
Does transradial access reduce mortality, bleeding, or vascular complications compared with transfemoral access in patients undergoing coronary angiography or PCI?
RCT (n=707)
Randomized
Yes
Does transradial access reduce mortality, bleeding, or vascular complications compared with transfemoral access in patients undergoing coronary angiography or PCI?
Absolute Event Rate: 1.4% vs 7.2%
p-value: p=0.0001
Transradial access is the preferred approach for coronary angiography and PCI due to significant reductions in bleeding and vascular complications compared to transfemoral access, without compromising ischemic outcomes.
OBJECTIVES: This study sought to compare radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) by high-volume operators experienced in both access sites. BACKGROUND: The exact clinical benefit of the radial compared to the femoral approach remains controversial. METHODS: STEMI-RADIAL (ST Elevation Myocardial Infarction treated by RADIAL or femoral approach) was a randomized, multicenter trial. A total of 707 patients referred for STEMI <12 h of symptom onset were randomized in 4 high-volume radial centers. The primary endpoint was the cumulative incidence of major bleeding and vascular access site complications at 30 days. The rate of net adverse clinical events (NACE) was defined as a composite of death, myocardial infarction, stroke, and major bleeding/vascular complications. Access site crossover, contrast volume, duration of intensive care stay, and death at 6 months were secondary endpoints. RESULTS: The primary endpoint occurred in 1.4% of the radial group (n = 348) and 7.2% of the femoral group (n = 359; p = 0.0001). The NACE rate was 4.6% versus 11.0% (p = 0.0028), respectively. Crossover from radial to femoral approach was 3.7%. Intensive care stay (2.5 ± 1.7 days vs. 3.0 ± 2.9 days, p = 0.0038) as well as contrast utilization (170 ± 71 ml vs. 182 ± 60 ml, p = 0.01) were significantly reduced in the radial group. Mortality in the radial and femoral groups was 2.3% versus 3.1% (p = 0.64) at 30 days and 2.3% versus 3.6% (p = 0.31) at 6 months, respectively. CONCLUSIONS: In patients with STEMI undergoing primary PCI by operators experienced in both access sites, the radial approach was associated with significantly lower incidence of major bleeding and access site complications and superior net clinical benefit. These findings support the use of the radial approach in primary PCI as first choice after proper training. (Trial Comparing Radial and Femoral Approach in Primary Percutaneous Coronary Intervention [PCI] [STEMI-RADIAL]; NCT01136187).
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Bernát et al. (2013) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=707). Radial approach vs. Femoral approach was evaluated on Cumulative incidence of major bleeding and vascular access site complications at 30 days (p=0.0001). The radial approach significantly reduced the 30-day incidence of major bleeding and access site complications to 1.4% compared to 7.2% with the femoral approach in STEMI patients.
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