Fundamentals: Previous studies have shown the benefits of a transradial approach in the context of coronary syndromes with ST-segment elevation. The aim of this study was to evaluate these benefits in AMI patients with ST-segment elevation within a window of up to 12 hours from the onset of symptoms.
Methods: A randomized study conducted in Canada and the Czech Republic evaluated 707 patients with ACS with supra ST up to 12 hours of evolution from the start to the primary angioplasty through radial or femoral routes. All the selected centers had great experience with radial access, (80% of transradial primary angioplasty). The primary study endpoint was the occurrence of major bleeding, (classified according to the HORIZONS Studio), and complications related to the puncture site, (hematoma> 15 cm). Secondary objectives were: MACE (death, MI, stroke), contrast volume, procedure success, stay duration in a closed unit, procedure length and fluoroscopy.
Exclusion criteria were: Killip IV on admission, radial /femoral pulse absence, oral anticoagulants, prior aortofemoral bypass surgery, negative Allen test or Barbeau test type D. There were no differences with respect to baseline characteristics in the patients. The average symptom-to-balloon time was 210-215 minutes, (with no difference between groups). The crossover rate radial to femoral group was 3.7%, the use of glycoprotein inhibitors IIb / IIIa was 45% in both groups, suction catheters were used in 28% of patients, (no difference between groups).
There was no difference in relation to the procedure time and fluoroscopy between groups. The contrast volume and closed unit length of stay was higher in the femoral group, (182 ± 60 vs.170 ± 71 ml, p = 0.01, and 3.0 ± 2.9 vs. 2.5 ± 1.7 days, p = 0.0016, for the radial and femoral groups respectively). As for the primary endpoint, there was a reduction in the radial group, (1.4 vs. 7.2%, p = 0.0001), while MACE did not differ between groups. When analyzing MACE, (death, myocardial infarction and stroke), together with bleeding, there was a 38% reduction in the radial group, (4.6% versus 11%, p = 0.0028).
Conclusions: In patients with clinical presentation and AMI with supra ST <12hrs, the radial approach was associated with a significant reduction in the incidence of major bleeding and related complications. The use of the radial path decreased the time spent in a closed unit and the volume of contrast used.
Editorial Comment: The findings of this study corroborate the results of previous tests such as the RIVAL and RIFLE, showing that the use of this approach is safe and effective, it does not increase the symptom-balloon time or the duration of the procedure. A reduction in complications related to the path was expected but it is noteworthy that the participating centers had great experience with radial access, (80% of cases were done this way). This in turn led to a low rate of crossover, (3%), which is consistent with previous studies.
Ivo Bernat
2012-10-26
Original title: STEMI RADIAL: A Prospective, Randomized Trial of Radial vs. Femoral Access in Patients with ST-Segment Elevation Myocardial Infarction.
