Acute myocardial infarction (AMI) patients who undergo PCI have the same 30-day mortality regardless of whether radial or femoral access is used for PCI, according to results of the SAFARI-STEMI trial presented March 18 at ACC.19 in New Orleans, LA.

Michel Le May, MD, FACC, et al., enrolled 2,292 STEMI patients from five medical centers across Canada. All patients underwent PCI; half were randomly assigned to radial access and the other half to femoral access. Most patients received bivalirudin and ticagrelor to prevent blood clots during and after PCI, respectively. The researchers had initially planned to enroll 5,000 patients, but stopped enrollment early when an analysis indicated it would not be possible to reach the primary endpoint of a 1.5 percent difference in 30-day mortality.

According to the results, 30-day mortality was 1.5 percent in the radial access group vs. 1.3 percent in the femoral access group. Rates of secondary outcomes, including subsequent AMI, blood clots and bleeding complications, were not significantly different between the two groups.

The researchers concluded that STEMI patients should have similar results after PCI for either radial or femoral access. They note that clinicians should be able to perform PCI using either approach because it is sometimes necessary to switch access sites for certain patients during the procedure.

“I think it will be important for medical training programs to emphasize the need to be proficient at both the radial and femoral access,” Le May said. “It is possible to become deskilled at doing one of the procedures, and a consistent emphasis on one approach over the other can lead to an increase in complications.”

The study is unique in that it included only STEMI patients, and the two PCI approaches may have different results in patients without STEMI or certain subgroups of STEMI patients, the researchers note.

Keywords: ACC Annual Scientific Session, ACC19, Percutaneous Coronary Intervention, Radial Artery, Acute Coronary Syndrome

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