title: ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial.
abstract: OBJECTIVE
  This study 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.
  
  
  BACKGROUND
  The exact clinical benefit of the radial compared to the femoral approach remains controversial.
  
  
  METHODS
  STEMI-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.
  
  
  RESULTS
  The primary 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.
  
  
  CONCLUSIONS
  In patients 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).
authors.affiliation: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic. Electronic address: ivobernat@gmail.com.
authors.forename: Ivo
authors.initials: I
authors.lastname: Bernat
authors.affiliation: Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Horak
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Stasek
authors.affiliation: Na Homolce Hospital Prague, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Mates
authors.affiliation: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Pesek
authors.affiliation: Na Homolce Hospital Prague, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Ostadal
authors.affiliation: Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: Vlado
authors.initials: V
authors.lastname: Hrabos
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Dusek
authors.affiliation: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Koza
authors.affiliation: Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Sembera
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Brtko
authors.affiliation: Na Homolce Hospital Prague, Prague, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Aschermann
authors.affiliation: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Smid
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Polansky
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Abdul
authors.initials: A
authors.lastname: Al Mawiri
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Vojacek
authors.affiliation: University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Bis
authors.affiliation: Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.affiliation: Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
authors.forename: Richard
authors.initials: R
authors.lastname: Rokyta
mesh_terms: D002406:Catheterization, Peripheral / Q000379:methods*; D018153:Czech Republic / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: ST-segment elevation myocardial infarction; coronary intervention; radial approach