title: Radial versus femoral access for angioplasty of ST-segment elevation acute myocardial infarction with second-generation drug-eluting stents.
abstract: OBJECTIVE
  Invasive and pharmacological treatment of ST-segment elevation acute myocardial infarction reduces the rate of ischemic events but not bleeding complications. The objective of this study was to compare clinical results and bleeding complications between femoral and radial access routes in patients with ST-segment elevation acute myocardial infarction.
  
  
  METHODS
  An evaluation was performed of the population of the Examination study, a randomized, multicenter, clinical trial that included 1498 patients with ST-segment elevation acute myocardial infarction who underwent emergency angioplasty. Subanalysis of this population was conducted to compare patients by type of access (femoral vs radial). The primary end point was a composite of: all-cause death, myocardial infarction, revascularization, and bleeding.
  
  
  RESULTS
  Femoral and radial access routes were used in 825 (55%) and 673 (45%) patients, respectively. More bleeding complications (major and minor) were seen with femoral access than radial access (5.9% vs 2.8%; P<.004), largely due to a greater incidence of minor bleeding with femoral access (4.6% vs 1.9%; P=.005). After adjustment for confounders, survival analysis showed a reduction in the primary composite end point in patients with radial access (hazard ratio=0.73; 95% confidence interval, 0.56-0.96; P=.022).
  
  
  CONCLUSIONS
  In patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications.
authors.affiliation: Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Vicens
authors.initials: V
authors.lastname: Marti
authors.affiliation: Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: García-Picart
authors.affiliation: Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Delgado
authors.affiliation: Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Servicio de Cardiología, Hospital do Meixoeiro, Vigo, Pontevedra, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.affiliation: Servicio de Cardiología, Hospital San Carlos, Madrid, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez-Antolin
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.affiliation: Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.affiliation: Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. Electronic address: masabate@clinic.ub.es.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D054855:Drug-Eluting Stents; 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*; D011446:Prospective Studies; D011474:Prosthesis Design; D017534:Radial Artery; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Angioplastia coronaria; Bleeding; Coronary angioplasty; Hemorragia; Infarto de miocardio; Myocardial infarction