Radial access for STEMI patients

1. Radial Access for STEMI
A comprehensive update
Josef Ludwig

5. Mortality and Bleedings

7. 2008
n=32 822
n= 7952 (25%)

9. Brück M et al.2009
FA-Center

12. 0%
25%
50%
75%
100%
0%
5%
10%
Complication
NS - 0.08 - 0.01
RA
Success
Depending on complication
definition
FA
RIVAL STEACS

13. Date of download:
1/14/2015
Copyright © The American College of Cardiology.
All rights reserved.
From: Radial Versus Femoral Access for Primary Percutaneous Interventions in ST-Segment Elevation
Myocardial Infarction Patients: A Meta-Analysis of Randomized Controlled Trials
J Am Coll Cardiol Intv. 2013;6(8):814-823. doi:10.1016/j.jcin.2013.04.010
All-Cause Mortality
Meta-analysis of pooled data from randomized studies showing the effect of radial versus femoral access approach on risk of death
in STEMI patients treated with primary PCI. CI = confidence interval; other abbreviations as in Table 1.
Figure Legend:

14. Based on the current data, the radial
approach to PCI in STEMI patients
appears to be the preferred approach
for experienced radial operators

15. Limitation of Radial Trials
• Performed by Radial operators
only.
RA-Operator
RA FA
Do we need to randomize the
operators, because
FA-Operators are better FA-
Operators than RA-operators
FA-Operator
FA

19. • PCI for STEMI using radial access requires
experienced operators at high-volume radial
catheterization laboratories. This was
common in all of the studies included, and
though exact definition of an experienced
radial operator is unclear, a steep radial access
learning curve is well recognized.

21. ©2013EuroIntervention.Allrightsreserved.
EuroIntervention 2013;8:1242-1251 published online ahead of print January 2013
Consensus document on the radial approach in percutaneous cardiovascular interventions:
position paper by the European Association of Percutaneous Cardiovascular Interventions and
Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology

22. Simple Summary
• RA-operators should do RA in STEMI
• FA-operators should do FA in STEMI

23. Never Forget!!!
• The primary aim of primary PCI is to treat
STEMI and restore blood flow to the heart and
not to avoid access site complication