title: Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial.
abstract: OBJECTIVE
  We sought to determine whether a transradial (TR) approach compared with a transfemoral (TF) approach was associated with improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in a post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data comparing the TR approach with the TF approach in patients with STEMI treated with primary PCI and contemporary anticoagulant regimens.
  
  
  RESULTS
  In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340 patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints included the 30-day and one-year rates of major adverse cardiovascular events (MACE: death, reinfarction, stroke or target vessel revascularisation), non CABG-related major bleeding, and net adverse clinical events (NACE: MACE or major bleeding). TR compared to TF access was associated with significantly lower 30-day rates of composite death or reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95], p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year, the TR group still had significantly reduced rates of death or reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89], p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By multivariable analysis, TR access was an independent predictor of freedom from MACE and NACE at 30 days and one year.
  
  
  CONCLUSIONS
  In patients with STEMI undergoing primary PCI with contemporary anticoagulation regimens in the HORIZONS-AMI trial, a TR compared with a TF approach was associated with reduced major bleeding and improved event-free survival.
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Jan Z
authors.initials: JZ
authors.lastname: Peruga
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Martin P
authors.initials: MP
authors.lastname: Fahy
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D000991:Antithrombins / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010446:Peptide Fragments / Q000627:therapeutic use; D011446:Prospective Studies; D017534:Radial Artery; D011994:Recombinant Proteins / Q000627:therapeutic use; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin