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 Olivecrona1 On behalf of the investigators Bo Lagerqvist2, Matthias Gotberg1, Stefan James2, Mike Koutouzis3, Per Albertsson3 , Jan Harnek1 1Department 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 interest Speaker’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)

4. Increase in use of the Transradial approach in STEMI patients 2005-2010 in Sweden

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 Backgrounds Background characteristics total cohort. Patient and clinical factors:

8. Results Procedure

9. Results Outcome

10. AdjustedCumulative Risk of death for up to 1 year: transfemoral vs. transradial access site Adjusted 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% CI 0.66 (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]