http://www.theheart.org/web_slides/1337573.do A prospective, randomized, multicenter trial comparing the safety and efficacy in the prevention of net adverse clinical outcomes (NACE) of transfemoral vs. Transradial approach for the treatment of patients with ST-elevation acute coronary syndrome (STEACS) udergoing primary angioplasty

1. RIFLE STEACS (Radial versus Femoral
Randomized Investigation in ST Elevation
Acute Coronary Syndrome)

2. RIFLE STEACS (Radial versus Femoral Randomized
Investigation in ST Elevation Acute Coronary Syndrome)
E Romagnoli (Policlinico Casilino, Rome, Italy)
TCT 2011
• A prospective, randomized, multicenter trial comparing the safety and efficacy
in the prevention of net adverse clinical outcomes (NACE) of transfemoral vs.
transradial approach for the treatment of patients with ST-elevation acute
coronary syndrome (STEACS) undergoing primary angioplasty
• Population and treatment:
1001 patients with STEMI
Randomized to radial- or femoral-access PCI
• Primary end point:
Composite of bleeding and MACCE, a composite known as the NACE rate,
at 30 days
MACCE=major adverse cardiac and cerebrovascular events

3. RIFLE STEACS: Results
• Greater reduction in overall NACE rate at 30 days in the femoral-access group
than in the radial-access group: 21.0% vs 13.6%, respectively (p=0.003)
• MACCE rate—a composite of cardiac death, MI, target lesion revascularization,
and stroke—was also significantly reduced: 11.4% in the femoral-access group
and 7.2% in the radial-access group (p=0.029)
Largely driven by a significant reduction in cardiac death (5.2% in the radial-
access group and 9.2% in the femoral-access group; p=0.20)
Bleeding:
• Bleeding rates also significantly reduced in the radial-access group vs femoral-
access: 7.8% vs 12.2%, respectively (p=0.026)
The reduction in bleeding complications was driven almost entirely by a 47%
reduction in access-site bleeds

4. RIFLE STEACS: Commentary*
"This is a strong message of the study, an important reduction [in cardiac death]."
- Dr Enrico Romagnoli
"What I think we need to be careful with is if clinicians aren't doing very much radial-
access PCI, who don't have the expertise, the results can't be applied to them . . .
They need to be trained first."
- Dr Sanjit Jolly
"The radial approach needs to be incorporated into the training guidelines,
particularly in the United States."
- Dr Sunil Rao
*All comments from RIFLE STEACS: Lower risk of MACCE with radial-access PCI in STEMI patients
(http://www.theheart.org/article/1307661.do)

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