{"id":30794,"date":"2012-08-02T12:20:21","date_gmt":"2012-08-02T16:20:21","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=30794"},"modified":"2012-08-02T12:54:08","modified_gmt":"2012-08-02T16:54:08","slug":"survival-better-with-a-radial-vs-femoral-pci-approach-sleight-of-hand","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/08\/02\/survival-better-with-a-radial-vs-femoral-pci-approach-sleight-of-hand\/","title":{"rendered":"Survival Better with a Radial (vs. Femoral) PCI Approach: Sleight of Hand?"},"content":{"rendered":"

Patients with an ST-segment-elevation acute coronary syndrome treated with primary (or rescue) PCI have better survival<\/a> when the procedure is performed using a radial approach rather than a femoral approach.<\/p>\n

That\u2019s one of the findings of the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) <\/a>multicenter trial, in which 1001 participants with ST-segment-elevation ACS undergoing primary or rescue PCI were randomized to either a radial or a femoral approach at 4 high-volume centers.<\/p>\n

The primary composite endpoint was the 30-day rate of net adverse clinical events (NACEs), defined as cardiac death, stroke, MI, target-lesion revascularization, or bleeding. The individual NACE components were secondary endpoints.<\/p>\n

Results:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Event (30 days)<\/strong><\/p>\n<\/td>\n

\n

Radial approach<\/strong><\/p>\n<\/td>\n

\n

Femoral approach<\/strong><\/p>\n<\/td>\n

\n

P <\/em><\/strong>value<\/strong><\/p>\n<\/td>\n<\/tr>\n

NACEs<\/em><\/td>\n\n

13.6%<\/p>\n<\/td>\n

\n

21.0%<\/p>\n<\/td>\n

\n

0.003<\/p>\n<\/td>\n<\/tr>\n

Cardiac death<\/em><\/td>\n\n

5.2%<\/p>\n<\/td>\n

\n

9.2%<\/p>\n<\/td>\n

\n

0.02<\/p>\n<\/td>\n<\/tr>\n

MI<\/em><\/td>\n\n

1.2%<\/p>\n<\/td>\n

\n

1.4%<\/p>\n<\/td>\n

\n

1.00<\/p>\n<\/td>\n<\/tr>\n

Stroke<\/em><\/td>\n\n

0.8%<\/p>\n<\/td>\n

\n

0.6%<\/p>\n<\/td>\n

\n

0.725<\/p>\n<\/td>\n<\/tr>\n

Target-lesion revascularization<\/em><\/td>\n\n

1.2%<\/p>\n<\/td>\n

\n

1.8%<\/p>\n<\/td>\n

\n

0.604<\/p>\n<\/td>\n<\/tr>\n

Bleeding<\/em><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0 \u00a0— access site<\/td>\n\n

2.6%<\/p>\n<\/td>\n

\n

6.8%<\/p>\n<\/td>\n

\n

0.002<\/p>\n<\/td>\n<\/tr>\n

\u00a0 \u00a0— major<\/td>\n\n

1.8%<\/p>\n<\/td>\n

\n

2.8%<\/p>\n<\/td>\n

\n

0.399<\/p>\n<\/td>\n<\/tr>\n

\u00a0 \u00a0— fatal<\/td>\n\n

0.6%<\/p>\n<\/td>\n

\n

0.6%<\/p>\n<\/td>\n

\n

0.684<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

The radial and femoral groups were similar with respect to:<\/p>\n

– baseline and clinical variables
\n– periprocedural anticoagulant and antithrombotic therapies
\n– symptom-to-presentation and door-to-balloon times
\n– postprocedure MI, stroke, or target-lesion revascularization
\n– major or fatal bleeding<\/p>\n

We can’t think of a plausible explanation for why the radial approach was associated with lower mortality than the femoral approach in this clinical population.\u00a0Can you?\u00a0Are they pulling our leg?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Is there a plausible explanation for why the radial approach to PCI would yield better survival than the femoral approach in patients with ST-segment ACS?<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[239,301,302,1386],"class_list":["post-30794","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-acs","tag-pci","tag-primary-pci","tag-rescue-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/30794","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=30794"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/30794\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=30794"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=30794"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=30794"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}