The transradial approach (TRA) has been recommended for patients with ST-elevation myocardial infarction (STEMI) for reduced bleeding complications and mortality. However, evidence in support of the use of distal radial access (DRA) in these patients is limited. This study aimed at showing DRA puncture success rate would be no inferior than that of TRA.
Primary endpoint was puncture success rate. Secondary endpoints included coronary angiography and angioplasty success rates, bleeding complications, puncture, procedural, hemostasis and fluoroscopy time, contrast volume, and major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, and revascularization.
A total of 354 patients were randomized: 174 were assigned to DRA and 175 to TRA. Puncture success rate resulted 94.3% for DRA patients vs. 96.1% for TRA.
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Access site bleeding was more frequent among TRA patients vs. DRA, though not statistically significant. No significant differences were found when looking at secondary endpoints.
Conclusión
In this multicenter study of STEMI patients, DRA vs TRA puncture success rate resulted inconclusive in both intention-to-treat and per-protocol analyses. However, DRA was shown non-inferior based on treatment. Large-scale studies are needed to confirm these findings.
Original Title: Comparison of Puncture Success Rate between Distal Radial Access and Transradial Access in Patients with ST-elevation Myocardial Infarction.
Reference: Jun-Won LEE, MD, PhD et al TCT 2024.
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