Abstract
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. Within STrategic 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 multivariab...Continue Reading
References
Apr 4, 1985·The New England Journal of Medicine·UNKNOWN TIMI Study Group
Sep 2, 1993·The New England Journal of Medicine·UNKNOWN GUSTO investigators
Dec 24, 2005·American Journal of Epidemiology·Tobias KurthJames M Robins
Jun 15, 2007·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Nicholas L M CrudenDavid E Newby
Sep 10, 2008·Circulation·Christopher E BullerPaul W Armstrong
Dec 17, 2008·American Heart Journal·Sanjit S JollyShamir R Mehta
Jul 6, 2010·American Heart Journal·Paul W ArmstrongUNKNOWN STREAM Steering Committee
Feb 18, 2012·Heart·Cathy JohnmanColin Berry
Aug 4, 2012·Journal of the American College of Cardiology·Enrico RomagnoliGiuseppe Sangiorgi
Aug 28, 2012·European Heart Journal·UNKNOWN Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)Doron Zahger
Oct 30, 2012·Journal of the American College of Cardiology·Shamir R MehtaUNKNOWN RIVAL Investigators
Dec 15, 2012·Journal of the American College of Cardiology·Olivier F Bertrand, Tejas Patel
Jan 29, 2013·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Martial HamonUNKNOWN Working Group on Thrombosis on the European Society of Cardiology
Mar 12, 2013·The New England Journal of Medicine·Paul W ArmstrongUNKNOWN STREAM Investigative Team
Oct 15, 2013·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Sunil V RaoSamir B Pancholy
Nov 12, 2013·Journal of the American College of Cardiology·Ivo BernatRichard Rokyta
Aug 12, 2014·The American Journal of Cardiology·Robert C WelshPaul W Armstrong
Jan 27, 2015·JACC. Cardiovascular Interventions·Karim RatibUNKNOWN British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research
Mar 21, 2015·Lancet·Marco ValgimigliUNKNOWN MATRIX Investigators
Jun 10, 2015·Circulation. Cardiovascular Interventions·Martial HamonPhilippe Gabriel Steg
Jan 1, 2016·JACC. Cardiovascular Interventions·Mitul B KadakiaJay Giri