Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study

Abstract

BackgroundThe effectiveness of radial access (RA) in ST‐elevation myocardial infarction (STEMI) has been predominantly established in primary percutaneous coronary intervention (pPCI) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral (FA) access in STEMI undergoing either a pharmacoinvasive (PI) strategy or pPCI.Methods and ResultsWithin STrategic Reperfusion Early After Myocardial Infarction (STREAM), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site (FA: PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ST‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients (P<0.001). On multivariable analysis, this benefit on the primary composite outcome favoring RA persisted (adjusted odds ratio [OR], 0.59; 95% CI, 0.44–0.78; P<0.001) and was evident in both pPCI (adjusted OR, 0.63; 95% CI, 0.43–0.92) and PI cohorts (adjusted OR, 0.57 95% CI, 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group (RA vs FA, 5.2% vs 6.0%; P=0.489).ConclusionsRegardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00623623.

Radial versus femoral access percutaneous coronary intervention in patients with acute myocardial infarction: Experience from a Southeast Asian country PCI registry

“…Thus, our results confirm the previous studies which show significant reductions in MACE and bleeding complications (27). In cases of rescue PCI and pharmaco-invasive PCI strategy, the trans-radial approach is also preferred to reduce the bleeding risk (28,29).…”

Melatonin suppresses platelet activation and function against cardiac ischemia/reperfusion injury via PPARγ/FUNDC1/mitophagy pathways

“…Cardiac I/R injury is a phenomenon in which the cellular damage is initiated during hypoxia or anoxia but becomes exacerbated when oxygen is redelivered to the tissue . Cardiomyocytes are potential target cells of I/R injury, and therefore, the majority of studies have focused on effective treatment to enhance the tolerance of cardiomyocytes to I/R injury . In fact, cardiomyocyte injury is largely derived from platelet micro‐thrombosis and microcirculation perfusion defect, which unfortunately results in a second ischemic event in myocardial tissues despite successful reperfusion of the epicardial coronary vessels according to our previous clinical studies .…”

Temporal Trends in in-Hospital Bleeding and Transfusion in a Contemporary Canadian ST-Elevation Myocardial Infarction Patient Population

“…The radial approach is known to have a lower incidence of major bleeding and access site bleeding. [23][24][25] The most robust evidence supporting the radial approach was published by Ferrante et al in 2016, which included a meta-analysis of 24 trials including 22,843 patients. 26 All end points including major bleeding, all-cause mortality, and major adverse cardiovascular events were lower in patients who underwent a radial approach.…”