Radial versus femoral approach in STEMI: what do we know so far?

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• The radial artery approach has emerged as a key alternative to femoral access for coronary angiography since 1989.
• Advancements in dedicated equipment have enhanced the efficacy of radial access, even in complex cardiac procedures.
• ST-elevation myocardial infarction (STEMI) is associated with high bleeding risk, and minimizing bleeding is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of the radial approach compared to femoral access in STEMI patients.
• To synthesize evidence from observational studies and large randomized trials regarding transradial access outcomes.
• To determine if radial access should be the default strategy for patients with acute coronary syndrome (ACS) undergoing invasive procedures.

Main Methods:

• Review of observational studies comparing radial and femoral access in STEMI patients.
• Analysis of data from major randomized controlled trials, including RIVAL and MATRIX.
• Assessment of access site-related complications, mortality, and net clinical adverse events (NACE).

Main Results:

• Observational studies and large trials like RIVAL and MATRIX show reduced bleeding rates with radial access in ACS and STEMI patients.
• The RIVAL trial demonstrated lower mortality and NACE in the STEMI subgroup using radial access.
• The MATRIX trial confirmed that radial access decreases bleeding and all-cause death, reducing NACE in ACS patients.

Conclusions:

• Transradial access is associated with significant reductions in bleeding and mortality, particularly in STEMI patients.
• Evidence supports transradial access as a highly recommendable and preferable alternative to transfemoral access for ACS.
• Radial access should be considered the default approach for invasive management in patients with ACS.