This document summarizes the results of a study analyzing outcomes of 21,000 STEMI patients who underwent primary PCI via either transradial or transfemoral access. The study found lower adjusted 30-day and 1-year mortality rates, as well as lower bleeding complications, in patients who received transradial access compared to transfemoral access. Younger patients and males experienced even greater mortality benefit from the transradial approach. While the results suggest potential survival benefits with transradial PCI, the authors call for a large randomized controlled trial to confirm whether this access method can reduce mortality.

1. Lower Mortality with Transradial PCI Compared to Transfemoral PCI in 21 000 Patients with Acute Myocardial Infarction- Results from the SCAAR Database Presented by Goran K Olivecrona1On behalf of the investigatorsBo Lagerqvist2, Matthias Gotberg1, Stefan James2, Mike Koutouzis3, Per Albertsson3 , Jan Harnek11Department of Cardiology, Skåne University Hospital- Lund , 2Uppsala Clinical Research Center,Uppsala University, Uppsala, 3Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.

2. Potential conflicts of interestSpeaker’s name: Göran OlivecronaI have the following potential conflicts of interest to report:  Research contracts Consulting Abbott Vascular, Cordis B Braun, Terumo Edwards Lifesciences Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s)

3. IntroductionBleeding complications during PCI, including those from the access site, are a significant predictor of mortality. During study period 2005-2010, the number of Primary PCI procedures performed with the transradial access increased greatly in Sweden.Several trials have reported lower access site and bleeding complications in transradial compared to transfemoral PCI procedures.  The objective of this retrospective analysis was to study mortality in a large ST-elevation myocardial infarction (STEMI) cohort treated with the transradial approach during primary PCI, compared to the transfemoral approach.

4. Increase in use of the Transradial approach in STEMI patients2005-2010 in Sweden

5. Methods During time period 2005-2010, 25 374 STEMI patients were treated with Primary PCI in Sweden and data entered into the Swedish Coronary and Angioplasty Registry (SCAAR). The study is a retrospective analysis of the outcome of patients treated with either the transfemoral or the transradial approach. To avoid selection bias, the following patient groups were excluded from analysis: * Prior coronary bypass graft surgery (CABG) * Cardiogenic shock * Transfemoral and transradial puncture in the same patient. * Use of intraaortic balloon pump (IABP) * Patients on coumadine treatment * Patients with incomplete data

6. Methods A cohort of 21 339 STEMI patients then remained for analysis All cause mortality at 30 days and one year as well as bleeding complications were calculated through analysis of the nationwide complete SCAAR database and the Swedish death registry.  Multivariate analyses and Cox regression models were applied for measurement of 30 day and one year mortality as well a bleeding complications.

7. Patient BackgroundsBackground characteristics total cohort.Patient and clinical factors:

8. ResultsProcedure

9. ResultsOutcome

10. AdjustedCumulative Risk of death for up to 1 year:transfemoral vs. transradial access siteAdjusted OR (95% CI)0.78 (0.64-0.96) P= 0.018

11. Risk of death for up to 30 days:transradial vs. transfemoral access site(malevs. female)Favors Radial Favors Femoral OR 95% CI0.66 (0.51-0.86), p=0.002 0.78 (0.64-0.97), p=0.022

12. Risk of death for up to 30 days:transradial vs. transfemoral access site (by age)Favors Radial Favors Femoral OR 95% CI 0.59 [ 0.45-0.78]0.70 [0.53-0.93]1.12 [0.78- 1.61] 0.84 [0.50-1.42]

13. CONCLUSIONSRadial access in a cohort of 21 000 patients with STEMI treated with Primary PCI during 2005-2010 was associated with:a lower adjusted all cause mortalitya lower adjusted rate of bleeding complications a shorter adjusted hospital stay in a large cohort of STEMI patients.During the studied period, the number of patients with STEMI treated with Primary PCI through the radial access increased to >50% in Sweden.The analysis corroborates the finding of a lower mortality rate in the STEMI subset in the RIVAL study. A large prospective randomized trial is needed to confirm if primary PCI with the transradial access reduces mortality during primary PCI.