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Relationship Between Arterial Access and Outcomes in ST-Elevation Myocardial Infarction With a Pharmacoinvasive

Jay Shavadia1, Robert Welsh1, Anthony Gershlick2

  • 1Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.

Journal of the American Heart Association
|May 20, 2017
PubMed

Insights

Radial access (RA) in ST-elevation myocardial infarction (STEMI) improves outcomes compared to femoral access (FA), regardless of whether patients receive primary percutaneous coronary intervention (pPCI) or a pharmacoinvasive (PI) strategy. This finding supports RA as a preferred approach for STEMI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Radial access (RA) effectiveness in ST-elevation myocardial infarction (STEMI) is established for primary percutaneous coronary intervention (pPCI).
  • Limited data exists on RA versus femoral access (FA) in early postfibrinolytic STEMI patients.
  • The STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial provides insights into arterial access site impact.

Purpose of the Study:

  • To compare the effectiveness and safety of RA versus FA in STEMI patients undergoing either a pharmacoinvasive (PI) strategy or pPCI.
  • To evaluate the relationship between arterial access site and clinical outcomes in STEMI management.

Main Methods:

  • Analysis of 1820 STEMI patients from the STREAM trial.
  • Comparison of primary composite endpoint (death, shock, heart failure, reinfarction) and major bleeding between RA and FA groups.
  • Multivariable analysis adjusting for baseline characteristics and treatment strategy (PI vs. pPCI).

Main Results:

  • Radial access (RA) was associated with a significantly lower primary composite endpoint compared to femoral access (FA) (8.9% vs. 15.7%, P<0.001).
  • This benefit of RA persisted on multivariable analysis in both pPCI (aOR 0.63) and PI (aOR 0.57) cohorts.
  • No significant difference in non-intracranial major bleeding was observed between RA and FA groups (5.2% vs. 6.0%, P=0.489).

Conclusions:

  • Radial access (RA) is associated with improved clinical outcomes in STEMI patients, irrespective of the reperfusion strategy (PI or pPCI).
  • These findings reinforce existing evidence favoring RA for PCI in STEMI.
  • RA demonstrates a favorable safety profile regarding major bleeding compared to FA.
Abstract

Keywords:
ST‐segment elevation myocardial infarctionarterial accesspharmacoinvasive strategyprimary percutaneous coronary intervention

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