Radial access for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients reduces bleeding complications compared to femoral access. Several randomized controlled trials showed lower all-cause mortality with radial versus femoral access when performed by experienced radial operators. However, the studies only included radial operators, so it is unclear if the benefits seen with radial access would apply if femoral operators performed radial procedures or vice versa. Additionally, radial access requires experienced operators at high-volume centers, and the definition of an experienced radial operator remains uncertain due to the steep learning curve for radial procedures. The primary goal of primary PCI in STEMI is restoring blood flow to the heart, not avoiding access site complications.

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