Original article Radial Versus Femoral Access for Angioplasty of ST-segment Elevation Acute Myocardial Infarction With Second-generation Drug-eluting Stents Vicens Marti, a Salvatore Brugaletta, b Joan Garcı ´a-Picart, a Guillermo Delgado, a Angel Cequier, c Andre ´s In ˜ iguez, d Rosana Hernandez-Antolin, e Patrick Serruys, f Antonio Serra, a and Manel Sabate ´ b, * on behalf of the investigators of the Examination study a Servicio de Cardiologı´a, Hospital de Sant Pau, Barcelona, Spain b Servicio de Cardiologı´a, Hospital Clı´nic, Universitat de Barcelona, Barcelona, Spain c Servicio de Cardiologı´a, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain d Servicio de Cardiologı´a, Hospital do Meixoeiro, Vigo, Pontevedra, Spain e Servicio de Cardiologı´a, Hospital San Carlos, Madrid, Spain f Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands Rev Esp Cardiol. 2015;68(1):47–53 Article history: Received 18 November 2013 Accepted 20 February 2014 Available online 24 July 2014 Keywords: Coronary angioplasty Myocardial infarction Bleeding A B S T R A C T Introduction and objectives: Invasive and pharmacological treatment of ST-segment elevation acute myocardial infarction reduces the rate of ischemic events but not bleeding complications. The objective of this study was to compare clinical results and bleeding complications between femoral and radial access routes in patients with ST-segment elevation acute myocardial infarction. Methods: An evaluation was performed of the population of the Examination study, a randomized, multicenter, clinical trial that included 1498 patients with ST-segment elevation acute myocardial infarction who underwent emergency angioplasty. Subanalysis of this population was conducted to compare patients by type of access (femoral vs radial). The primary end point was a composite of: all-cause death, myocardial infarction, revascularization, and bleeding. Results: Femoral and radial access routes were used in 825 (55%) and 673 (45%) patients, respectively. More bleeding complications (major and minor) were seen with femoral access than radial access (5.9% vs 2.8%; P < .004), largely due to a greater incidence of minor bleeding with femoral access (4.6% vs 1.9%; P = .005). After adjustment for confounders, survival analysis showed a reduction in the primary composite end point in patients with radial access (hazard ratio = 0.73; 95% confidence interval, 0.56-0.96; P = .022). Conclusions: In patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications. ß 2014 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L.U. All rights reserved. Acceso radial frente a femoral en angioplastia por infarto agudo de miocardio con elevacio ´n del segmento ST con stent farmacoactivo de segunda generacio ´n Palabras clave: Angioplastia coronaria Infarto de miocardio Hemorragia R E S U M E N Introduccio ´n y objetivos: El tratamiento invasivo y farmacolo ´ gico del infarto agudo de miocardio con elevacio ´n del segmento ST comporta una reduccio ´n de los eventos isque ´ micos, no ası ´ de las complicaciones hemorra ´ gicas. El objetivo del estudio es evaluar en estos pacientes los resultados clı ´nicos y las complicaciones hemorra ´ gicas comparando el acceso femoral frente al radial. Me ´todos: Se evaluo ´a la poblacio ´n del estudio Examination, que es un ensayo clı ´nico multice ´ ntrico aleatorizado que incluyo ´a 1.498 pacientes con infarto agudo de miocardio con elevacio ´n del segmento ST remitidos para angioplastia de emergencia. Sobre esta poblacio ´ n, efectuamos un subana ´ lisis en el que se analizaron dos grupos segu ´n el tipo de acceso (femoral frente a radial). Se establecio ´ como objetivo primario la variable compuesta por: muerte por cualquier causa, infarto de miocardio, revascularizacio ´n y hemorragia. Resultados: El acceso fue por vı ´a femoral en 825 pacientes (55%) y por vı ´a radial en 673 (45%). Se observo ´ ma ´s hemorragias (mayores y menores) con acceso femoral que con acceso radial (el 5,9 frente al 2,8%; p < 0,004), guiado por mayor incidencia de hemorragias menores en acceso femoral frente a radial (el 4,6 frente al 1,9%; p = 0,005). El ana ´ lisis de supervivencia mostro ´ una reduccio ´n de la variable compuesta primaria en los pacientes con acceso radial (hazard ratio = 0,73; intervalo de confianza del 95%, 0,56-0,96; p = 0,022), teniendo en cuenta los factores confusores. * Corresponding author: Departamento de Cardiologı ´a, Instituto del To ´ rax, Hospital Clı ´nic, IDIBAPS, Villaroel 170, 08036 Barcelona, Spain. E-mail address: masabate@clinic.ub.es (M. Sabate ´). http://dx.doi.org/10.1016/j.rec.2014.02.024 1885-5857/ß 2014 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L.U. All rights reserved. Document downloaded from http://www.revespcardiol.org, day 01/04/2016. This copy is for personal use. 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