Distal Radial Access vs Transradial Access in Patients With ST-Segment Elevation Myocardial Infarction: The DRAMI...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Distal radial access (DRA) is an emerging alternative to transradial access (TRA) for coronary procedures.
• Limited evidence exists for DRA's efficacy in ST-segment elevation myocardial infarction (STEMI) patients.

Purpose of the Study:

• To evaluate if DRA is noninferior to TRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Main Methods:

• A multicenter, open-label, randomized controlled trial involving 354 STEMI patients.
• Patients were randomized to DRA or TRA, with puncture success rate as the primary endpoint.
• Noninferiority was tested using intention-to-treat, per-protocol, and as-treated analyses.

Main Results:

• The puncture success rate was 94.3% for DRA versus 96.1% for TRA (intention-to-treat analysis).
• DRA failed to demonstrate noninferiority in intention-to-treat and per-protocol analyses.
• Noninferiority was observed in the as-treated population; procedural success and safety were comparable between groups.

Conclusions:

• Distal radial access (DRA) did not meet noninferiority criteria for puncture success compared to transradial access (TRA) in STEMI patients.
• Both access routes exhibited similar procedural efficacy and safety profiles.
• Larger, powered studies are needed to confirm these findings and further validate DRA in STEMI.