For early invasive therapy for ST-segment elevation acute coronary syndrome (STEACS), the use of radial access instead of femoral access reduces bleeding complications and improves outcomes, according to the results of the first large randomized trial testing the two approaches in this population. The results of the Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome (RIFLE-STEACS) study were published online in the Journal of the American College of Cardiology.
Investigators in Italy and the Netherlands randomized 1,001 patients with acute STEACS to either the radial or femoral approach. At 30 days the composite of cardiac death, stroke, myocardial infarction, target lesion revascularization, and bleeding (net adverse clinical events, or NACEs) was significantly lower in the radial group than in the femoral group. Cardiac deaths, bleeding complications were also reduced in the radial group, though there were no significant differences in MI, target lesion revascularization, or stroke. Hospital stay was shorter in the radial group.
- NACEs: 13.6% in the radial group vs 21% in the femoral group, p= 0.003
- cardiac deaths: 5.2% vs 9.2%, p =0.020)
- bleeding: 7.8% vs 12.2%, p =0.026
- hospital stay: 5 days vs 6 , p =0.03
The door-to-balloon time was similar in the two groups, but radial access slightly prolonged the time from artery puncture to first balloon inflation.
The result, said the authors, “corroborates the link between mortality and ‘clinically relevant’ access site bleeding.” They speculated that the beneficial effect of the radial approach may be due to reductions in bleeding-related hemodynamic compromise, the need for blood transfusion, and lifesaving drug discontinuation. More rapid mobilization of the patient may also play a role.
Radial access, the authors concluded, “should become the recommended approach in these patients, provided adequate operator and center expertise is present.”