Author/Authors :
Bernat، نويسنده , , Ivo and Horak، نويسنده , , David and Stasek، نويسنده , , Josef and Mates، نويسنده , , Martin and Pesek، نويسنده , , Jan and Ostadal، نويسنده , , Petr and Hrabos، نويسنده , , Vlado and Dusek، نويسنده , , Jaroslav and Koza، نويسنده , , Jiri and Sembera، نويسنده , , Zdenek and Brtko، نويسنده , , Miroslav and Aschermann، نويسنده , , Ondrej and Smid، نويسنده , , Michal and Polansky، نويسنده , , Pavel and Al Mawiri، نويسنده , , Abdul and Vojacek، نويسنده , , Jan and Bis، نويسنده , , Josef and Costerousse، نويسنده , , Olivier F. Bertrand، نويسنده , , Olivier F. and Rokyta، نويسنده , , Richard، نويسنده ,
Abstract :
Objectives
tudy 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.
ound
act clinical benefit of the radial compared to the femoral approach remains controversial.
s
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.
s
imary 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.
sions
ients 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)
