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Vol. 68. Issue 1.
Pages 47-53 (January 2015)
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Vol. 68. Issue 1.
Pages 47-53 (January 2015)
Original article
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Radial Versus Femoral Access for Angioplasty of ST-segment Elevation Acute Myocardial Infarction With Second-generation Drug-eluting Stents
Acceso radial frente a femoral en angioplastia por infarto agudo de miocardio con elevación del segmento ST con stent farmacoactivo de segunda generación
Vicens Martia, Salvatore Brugalettab, Joan García-Picarta, Guillermo Delgadoa, Angel Cequierc, Andrés Iñiguezd, Rosana Hernandez-Antoline, Patrick Serruysf, Antonio Serraa, Manel Sabatéb,
Corresponding author

Corresponding author: Departamento de Cardiología, Instituto del Tórax, Hospital Clínic, IDIBAPS, Villaroel 170, 08036 Barcelona, Spain.
, on behalf of the investigators of the Examination study
a Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain
b Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
c Servicio de Cardiología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Servicio de Cardiología, Hospital do Meixoeiro, Vigo, Pontevedra, Spain
e Servicio de Cardiología, Hospital San Carlos, Madrid, Spain
f Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Figures (2)
Tables (4)
Table 1. Baseline Clinical and Anatomical Characteristics by Access Route
Table 2. Procedure Characteristics
Table 3. Clinical Events During Follow-up
Table 4. Predictors of the Composite End Point (Death, Infarction, Revascularization of the Treated Vessel, Bleeding) at 1 Year. Cox Regression Analysis
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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.


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.


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).


In patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications.

Coronary angioplasty
Myocardial infarction
Introducción y objetivos

El tratamiento invasivo y farmacológico del infarto agudo de miocardio con elevación del segmento ST comporta una reducción de los eventos isquémicos, no así de las complicaciones hemorrágicas. El objetivo del estudio es evaluar en estos pacientes los resultados clínicos y las complicaciones hemorrágicas comparando el acceso femoral frente al radial.


Se evaluó a la población del estudio Examination, que es un ensayo clínico multicéntrico aleatorizado que incluyó a 1.498 pacientes con infarto agudo de miocardio con elevación del segmento ST remitidos para angioplastia de emergencia. Sobre esta población, efectuamos un subanálisis en el que se analizaron dos grupos según el tipo de acceso (femoral frente a radial). Se estableció como objetivo primario la variable compuesta por: muerte por cualquier causa, infarto de miocardio, revascularización y hemorragia.


El acceso fue por vía femoral en 825 pacientes (55%) y por vía radial en 673 (45%). Se observó más 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 análisis de supervivencia mostró una reducción 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.


En pacientes con infarto agudo de miocardio con elevación del segmento ST, el acceso radial es una técnica eficaz para mejorar el pronóstico reduciendo las complicaciones hemorrágicas.

Palabras clave:
Angioplastia coronaria
Infarto de miocardio
Full Text


The femoral artery has been the approach of choice in 44.5% to 93.1% of invasive procedures in recent reports.1,2 This access route is frequently chosen because the radial approach requires proper patient selection and extensive operator experience and has a steep learning curve, particularly for ST-segment elevation myocardial infarction (STEMI).3,4 The most common complication in patients with acute coronary syndrome treated with angioplasty is bleeding, which is often associated with vascular access. Bleeding is associated with greater inhospital mortality and worse prognosis.5–7 In the current study, the clinical results and bleeding complications of the femoral approach were compared with those of the radial approach in consecutive patients included in the Examination study who underwent coronary angioplasty for STEMI.8

METHODSStudy Population

The Examination study is a prospective, 1:1 randomized, controlled, and multinational 12-center clinical trial that included consecutive patients with STEMI referred for emergency coronary angioplasty. Patients were included from 31 December 2008 to 15 May 2010. The electrocardiographic criteria of STEMI were ST-segment elevation ≥ 1mm in 2 or more standard leads or ≥ 2mm in 2 or more standard contiguous precordial leads or unknown left bundle branch block within the first 48h after symptom onset. The study was designed to compare clinical results between everolimus drug-eluting stents (Xience V, Abbott Vascular; Santa Clara, California, United States) and expandable cobalt chromium drug-free Multilink Vision stents (Abbott Vascular). The methodology and clinical results of the first year were recently published.8 This study was approved by the respective clinical research ethics committees of the participating hospitals and all patients provided written informed consent. For this randomized study, an unplanned cohort subanalysis was performed by establishing 2 groups according to approach: femoral vs radial.


All patients admitted with STEMI for emergency angioplasty received anticoagulant therapy and antiplatelet agents according to hospital protocol. A loading dose of acetylsalicylic acid (250-500mg) and clopidogrel (300-600mg) was administered before the procedure to patients who were not on chronic antiplatelet therapy. Anticoagulant therapy was performed with unfractionated or low-molecular-weight heparin. Bivalirudin or inhibitors of platelet glycoprotein IIb/IIIa receptors were used at the discretion of the catheterization cardiologist. Manual thrombectomy, followed by direct stenting, was the recommended revascularization strategy. The type of stent was randomly assigned by telephone call to the coordinating center. Patients were discharged with dual antiplatelet agent therapy: clopidogrel (75 mg/day) for at least 1 year and acetylsalicylic acid (100 mg/day) indefinitely. Data were analyzed by an independent CoreLab (Cardialysis BV; Rotterdam, The Netherlands).

Definitions and Follow-up

The primary end point of this study was a composite of: all-cause death, myocardial infarction, revascularization of the target vessel, and major or minor bleeding.9 Two groups were defined according to use of a femoral or radial vascular approach.

Major cardiac events were defined as all-cause death, myocardial infarction, and revascularization of the target vessel, in agreement with the Academic Research Consortium.10 Stent thrombosis was defined as “definite” when there was angiographic or autopsy confirmation; “probable” when there was sudden unexplained death within 30 days after the intervention or a documented infarction in the territory of the treated artery, and “possible” for all sudden unexplained death that occurred 30 days after the procedure.

Bleeding complications were defined as major bleeding when there was a decrease in hemoglobin values ≥ 5g/dL, a decrease in the hematocrit ≥ 15%, intracranial bleeding, or any bleeding associated with hemodynamic alterations that required blood transfusion. Minor bleeding was defined as a decrease in hemoglobin values of 3 to 5g/dL or in hematocrit of 12% to 15%, regardless of source.11

Follow-up was conducted via clinical visits or by telephone at 30 days, 6 months, and 1 year, and will continue until 5 years have passed.

Statistical Analysis

Clinical and baseline anatomical variables were tabulated, as well as those related to the procedure and clinical events during follow-up. A Student t test or Wilcoxon test was used to detect differences between continuous variables. A chi-square or Fisher exact test was used for categorical variables. The probability of event-free survival of the composite end point depending on type of vascular access was calculated using Kaplan-Meier survival analysis and a log rank test. A Cox proportional hazards model was used to identify independent predictive variables of the primary composite end point. A univariate analysis was performed to select variables to enter in the Cox analysis as predictors of the primary composite end point: only those variables with P<.01 were considered possible confounding factors (smoking, diabetes mellitus, hypertension, single-vessel disease, angioplasty and previous myocardial infarction, Killip class on admission, ejection fraction on discharge, and radial access use), age, sex, and extensive experience in the use of the radial approach (centers where more than 90% of cases were performed by radial access). Age and ejection fraction were entered as continuous variables, sex coded as female, and Killip class as class IV vs other classes. The other variables were entered as dichotomous variables, coding 1 as presence and 0 as absence. The significance of the resulting Cox model was tested and the variables were ranked. In addition, interactions between bleeding and other events in the primary composite end point were analyzed by repeating the survival analysis without the bleeding variable and the first-degree interaction between the type of stent implant and the type of arterial access. Results are expressed in absolute values, percentages, and mean (2 standard deviations). All comparisons were bilateral and were considered significant at P<.05. SPSS version 21 was used for all analyses.

RESULTSClinical and Anatomical Characteristics

Angioplasty was performed for STEMI in 1498 patients; access was via the femoral approach in 825 patients (55%) and via the radial approach in the remaining 673 patients (45%). The baseline clinical and anatomical characteristics are described in Table 1. No significant differences were seen between the patients that were operated on using femoral access vs radial access for age, sex, body surface, coronary risk factors (smoking, hypertension, and hypercholesterolemia), and history of revascularization. Access was largely femoral in patients with diabetes mellitus (P=.028) and with worse clinical status on admission (P=.021), and mainly radial in patients with previous angina (P=.028) and with multivessel heart disease (P=.023). Of the centers that participated in the study, 4 used the radial approach in > 90% of the included patients. In the other centers, the mean use of the radial approach was 18%. Of the 1498 randomized patients, 1460 (97%) had a 1-year follow-up.

Table 1.

Baseline Clinical and Anatomical Characteristics by Access Route

  Femoral (n=825)  Radial (n=673)  P 
Age, mean (SD), y  61.6 (12.3)  60.7 (12.5)  .140 
Women  159 (19.2)  95 (14.1)  .080 
BMI, mean (SD)  27.2 (3.8)  27.5 (3.8)  .167 
Risk factors       
Smoking  398 (48.2)  360 (53.4)  .094 
Hypertension  388 (47.0)  337 (50.0)  .250 
Diabetes mellitus  158 (19.1)  100 (14.8)  .028 
Hypercholesterolemia  356 (43.1)  299 (44.4)  .635 
Clinical history       
Previous myocardial infarction  43 (5.2)  37 (5.5)  .811 
Previous angioplasty  36 (4.3)  25 (3.7)  .524 
Previous aortocoronary bypass  8 (0.9)  8 (1.1)  .111 
Previous angina  220 (26.6)  214 (31.8)  .028 
Diseased vessel treated      .577 
Left main coronary artery  5 (0.6)  2 (0.3)   
LAD  365 (44.2)  285 (43.3)   
Cx  106 (12.8)  101 (15.0)   
RCA  348 (42.1)  283 (42.0)   
Saphenous vein  1 (0.1)  2 (0.3)   
Single-vessel CAD  730 (88.4)  571 (84.8)  .038 
Multivessel CAD  89 (10.8)  99 (14.3)  .023 
Heart rate, mean (SD), bpm  76.5 (17.2)  77.0 (17.0)  .636 
Systolic blood pressure, mean (SD), mmHg  126.9 (23.4)  124.9 (23.6)  .102 
Clinical status on admission, Killip class      .021 
731 (88.6)  606 (90.0)   
II  60 (7.2)  55 (8.2)   
III  15 (1.8)  8 (1.1)   
IV  16 (1.9)  2 (0.3)   
Ejection fraction at discharge, mean (SD), %  50.5 (10.7)  51.6 (10.1)  .096 

BMI, body mass index; CAD, coronary artery disease; Cx, circumflex artery; LAD, left anterior descending artery; RCA, right coronary artery; SD, standard deviation.

Unless otherwise indicated, data are expressed as No. (%) or mean (standard deviation).

Procedure Characteristics

Variables related to the procedure and the antiplatelet and anticoagulant therapies are shown in Table 2. The number of primary, rescue, facilitated, or late (> 48h) angioplasties, basal TIMI (Thrombolysis In Myocardial Infarction) flow, the model and number of stents implanted, thrombus aspiration, and counterpulsation balloon implantation were similar between the 2 vascular access routes. Access was largely radial in patients pretreated with acetylsalicylic acid (P=.003), sodium heparin (P<.001), and inhibitors of platelet glycoprotein IIb/IIIa receptors (P<.001). Worse TIMI flow after angioplasty was seen in patients whose access was via the femoral approach (P<.001).

Table 2.

Procedure Characteristics

  Femoral (n=825)  Radial (n=673)   
Angioplasty type      .273 
Primary  692 (83.8)  576 (85.5)   
Rescue  57 (6.9)  41 (6.1)   
Facilitated  24 (2.9)  10 (1.4)   
Late (> 48 h)  52 (6.3)  45 (6.6)   
Basal TIMI flow      .152 
505 (61.2)  373 (55.4)   
56 (6.7)  59 (8.7)   
108 (13.0)  91 (13.5)   
154 (18.6)  143 (21.2)   
Stent      .372 
Conventional  420 (50.9)  327 (48.5)   
Drug-eluting  405 (49.1)  356 (52.9)   
Number of implanted stents, mean (SD)  1.4 (0.6)  1.3 (0.6)  .643 
Antiplatelet therapy       
Acetylsalicylic acid  716 (86.7)  603 (89.6)  .003 
Clopidogrel  688 (83.4)  578 (85.8)  .110 
GPIIb/IIIa inhibitors  389 (47.1)  396 (58.8)  < .001 
Anticoagulant therapy       
Sodium heparin  628 (76.1)  561 (83.4)  < .001 
Low-molecular-weight heparin  76 (9.2)  57 (8.5)  .649 
Bivalirudin  54 (6.5)  51 (7.5)  .436 
Thrombus aspiration  539 (65.3)  437 (64.9)  .872 
Counterpulsation balloon  9 (1.1)  2 (0.3)  .605 
Postangioplasty TIMI flow      < .001 
25 (3.0)  1 (0.1)   
10 (1.2)  2 (0.3)   
45 (5.4)  14 (2.1)   
745 (90.3)  651 (96.7)   

GPIIb/IIIa, glycoprotein-IIb/IIIa; SD, standard deviation; TIMI, Thrombolysis In Myocardial Infarction.

Unless otherwise indicated, data are expressed as No. (%) or mean (standard deviation).


Bleeding (major/minor) was seen in 49 of the 825 patients operated on via femoral access (5.9%) and in 19 of the 673 patients operated on via radial access (2.8%; P<.004). The number of major bleeding cases was similar between femoral and radial approaches (Figure 1): major bleeding was seen in 13 patients who underwent a femoral approach (1.5%) and in 7 who underwent a radial approach (1.0%; P=.36). In contrast, minor bleeding was seen in 38 patients operated on via femoral access (4.6%) and in 13 operated on via radial access (1.9%; P=.005) (Figure 1).

Figure 1.

Percentages of major and minor bleeding complications by femoral vs radial access. NS, not significant.

Clinical Events During Follow-up and Predictive Factors

The incidence of stent thrombosis was independent of vascular approach. Moreover, there were no differences between the groups in the incidence of major cardiac events, all-cause death, myocardial infarction, or need for revascularization (Table 3). Kaplan-Meier analysis showed a greater number of events of the primary composite end point in patients with a femoral access, compared to radial access (hazard ratio [HR]=0.73); 95% confidence interval [95%CI], 0.56-0.96; P=.022), after adjusting for confounding factors (Figure 2). Independent risk factors of the primary composite end point are shown in Table 4, as identified by Cox regression analysis. The treatment variables of sodium heparin and administration of platelet glycoprotein IIb/IIIa receptor inhibitors were not predictive variables in the univariate model. There were no interactions between bleeding and other events in the primary composite end point, and there was no significant relationship in the survival model between the type of stent implanted and the type of arterial access.

Table 3.

Clinical Events During Follow-up

  Femoral (n=825)  Radial (n=673)   
30 days
All-cause death  15 (1.8)  10 (1.4)  .655 
Myocardial infarction  9 (1.0)  5 (0.7)  .722 
New PTCA  21 (2.5)  13 (1.9)  .875 
Definite/probable stent thrombosis  11 (1.3)  11 (1.6)  .976 
First year
All-cause death  31 (3.7)  21 (3.1)  .503 
Myocardial infarction  11 (1.3)  14 (2.0)  .262 
New PTCA  44 (5.3)  35 (5.2)  .909 
Definite/probable stent thrombosis  11 (1.3)  15 (2.2)  .187 
Bleeding (major/minor)  49 (5.9)  19 (2.8)  < .001 

PTCA, percutaneous transluminal coronary angioplasty.

Data are expressed as No. (%).

Figure 2.

Probability of event-free survival of the primary composite end point by femoral vs radial access.

Table 4.

Predictors of the Composite End Point (Death, Infarction, Revascularization of the Treated Vessel, Bleeding) at 1 Year. Cox Regression Analysis

  HR (95%CI)  P 
Radial access  0.73 (0.56-0.96)  .022 
Killip class (IV vs I-III)  1.61 (1.34-1.94)  .001 
Age  1.03 (1.01-1.04)  .001 
Female sex  0.84 (0.60-1.20)  .351 
Single-vessel disease  0.68 (0.49-0.95)  .024 
Diabetes mellitus  1.30 (0.96-1.75)  .093 
Smoking  1.04 (0.87-1.23)  .671 
Hypertension  1.35 (1.03-1.76)  .031 
History of previous infarction  2.42 (1.40-4.20)  .002 
History of previous PTCA  0.42 (0.19-0.92)  .030 
Extensive experience in use of radial access  0.58 (0.42-0.82)  .002 
Ejection fraction at discharge  0.99 (0.99-1.00)  .313 

95CI%, 95% confidence interval; HR, hazard ratio; PTCA, percutaneous transluminal coronary angioplasty.


Bleeding is a relatively common complication of coronary angioplasty that is associated with an increased mortality.5,6 The present study shows that a radial approach in patients with STEMI decreases the risk of minor bleeding and improves the primary end point. Thus, a radial access route can improve the safety and prognosis of patients with STEMI who undergo emergency angioplasty. The radial approach facilitates arterial hemostasis, early diagnosis, and treatment of complications, and also permits earlier patient mobility.

There is a wide interhospital and geographical variability in the use of the radial approach. In the ACUITY trial,12 which recruited 13 819 patients with acute coronary syndrome from 600 centers in 10 countries, radial access was used in only 6.2% of the patients.12 In another recent 29-country study, which included 9126 high-risk patients with acute coronary syndrome treated with angioplasty, the radial (and brachial) approach was used in 13.5% of patients.13 In the United States, the CathPCI Registry of the National Cardiovascular Data Registry reported that in 1 110 150 patients between 2010 and 2011 the radial approach was used in 8.3% of diagnostic procedures and in only 6.9% of angioplasties; 13% of the hospitals never used it.1,14 In contrast, use of the radial approach in other centers can reach 88% in patients with STEMI.15 In the Examination study, radial access was used in 45% of patients. This wide variability in the choice of access is because the femoral approach is considered by some centers to be the standard or traditional technique, due to the “optimal” control of catheters and because it allows immediate access for larger diameter devices. These factors probably at least partly explain why, paradoxically, the femoral approach is used more frequently in high-risk patients.

In the current study, each operator and each center determined the choice of access. A femoral access route was more commonly used in women, diabetic patients, and those in worse clinical condition on admission. In this subgroup of patients, the femoral approach was possibly chosen due to a need to obtain a rapid vascular access in patients with poor clinical status and due to a weak radial pulse or a small radial artery.16,17 The experience of the operators in performing primary percutaneous transluminal coronary angioplasty by radial access would also affect the analysis of the composite end point.

In high-risk patients treated with angioplasty, anticoagulant and antiplatelet therapy, particularly with glycoprotein IIb/IIIa inhibitors, reduces the rate of ischemic complications, but at the expense of an increase in the incidence of bleeding complications.18 In these patients, the radial approach reduces the rates of major and minor bleeding and transfusions.19–21 In the present study, a radial access route was primarily used in patients previously treated with heparin and glycoprotein IIb/IIIa inhibitors. In these patients, the radial approach was probably chosen by the catheterization cardiologist to minimize the risk of bleeding, which could explain why no differences in the incidence of major bleeding or in the reduction of major cardiac events were associated with the vascular access.7 In a multicenter study that included 9126 patients, the radial access route was used in 13.5% of the patients, and no association was found between a radial approach and a reduction in major bleeding and mortality.13 In a metaanalysis of 3224 patients, the rates of major cardiac events were also similar between radial and femoral groups (2.5% vs 2.4%; P=.7).7 However, in agreement with other authors,7,22–25 the rate of minor bleeding complications was higher with femoral than radial access in the present study: 4.6% for femoral access vs 1.9% for radial access. In contrast, in the ACUITY trial,12 the incidence of minor bleeding was 7.4% and 7.2%, respectively, and in the RIFLES-STEACS trial,23 the incidence was 7.2% and 4.0%, respectively. These differences can be attributed to predominant use of the femoral approach in the ACUITY trial, whereas more extensive use was made of glycoprotein IIb/IIIa inhibitors in high-risk patients in the RIFLE-STEACS trial.12,25

In our study, the primary composite end point occurred less often in patients with STEMI who were operated on with a radial approach than with a femoral approach. These results are in accordance with those of the recent randomized study RIFLE-STEACS,23 which compared the radial and femoral approaches in patients with STEMI. The composite end point of cardiac death, stroke, myocardial infarction, revascularization of the target vessel, and bleeding occurred in 13.6% of the patients with radial access and in 21% of the patients with femoral access (P=.003). In another randomized study, which included patients with STEMI and patients with non—ST-segment elevation myocardial infarction, the radial approach decreased the incidence of the composite end point of death, myocardial infarction, stroke, and non-bypass surgery-related major bleeding in patients with STEMI (3.1% vs 5.2%; P=.026).24 In contrast, no differences were seen among patients with non—ST-segment elevation acute myocardial infarction, which underlines the particular importance of using a radial approach in patients with STEMI.22


No quantification of the catheterization cardiologist's level of experience with the radial approach was performed in the multicenter and multinational Examination study. However, the low incidence of bleeding reflects operator proficiency with both femoral and radial approaches. The effectiveness of the radial approach and the clinical results obtained are closely linked to the volume of procedures performed by this route.22

The Examination study was designed to compare the long-term clinical results of a drug-eluting stent with those of a conventional stent in consecutive patients. The type of vascular approach was chosen by the catheterization cardiologist. Accordingly, there may be a selection bias because the operator may have chosen the approach based on the clinical and/or anatomical conditions of the patient. However, given that the Examination trial included about 70% of the patients evaluated in the participating centers, the current study presents results that closely approximate the “real world” situation of emergency angioplasty in consecutive patients with STEMI, with operator experience and patient characteristics determining the choice of access route.


In patients with STEMI who undergo emergency angioplasty, a radial access route significantly reduces the incidence of minor bleeding complications compared with the femoral approach, which translates into a reduction in the composite end point, but without differences in the remaining components (all-cause death, myocardial infarction, revascularization of the target vessel). Our results indicate that, within the therapeutic strategy of patients with STEMI, the radial approach is an effective technique for improving prognosis and reducing bleeding complications.


None declared.

G.J. Dehmer, D. Weaver, M.T. Roe, S. Milford-Beland, S. Fitzgerald, A. Hermann, et al.
A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011.
J Am Coll Cardiol, 60 (2012), pp. 2017-2031
B. Garcia del Blanco, J.R. Rumoroso Cuevas, F. Hernández Hernández, R. Trillo Nouche.
Registro Español de Hemodinámica y Cardiología Intervencionista. XXII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2012).
Rev Esp Cardiol, 66 (2013), pp. 894-904
C.R. Balwanz, U. Javed, G.D. Singh, E.J. Armstrong, J.A. Southard, G.B. Wong, et al.
Transradial and transfemoral coronary angiography and interventions: 1-year outcomes after initiating the transradial approach in a cardiology training program.
Am Heart J, 165 (2013), pp. 310-316
M. Hamon, C. Pristipino, C. Di Mario, J. Nolan, J. Ludwig, M. Tubaro, et al.
Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology.
Eurointervention, 8 (2013), pp. 1242-1251
J.W. Eikelboom, S.R. Mehta, S.S. Anand, C. Xie, K.A. Fox, S. Yusuf.
Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.
Circulation, 114 (2006), pp. 774-782
S.V. Manoukian, F. Feit, R. Mehran, M.D. Voeltz, R. Ebrahimi, M. Hamon, et al.
Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY trial.
J Am Coll Cardiol, 49 (2007), pp. 1362-1368
P. Agostoni, C.G. Biondi-Zoccai, M.L. De Benedictis, S. Rigattieri, M. Turri, M. Anselmi, et al.
Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures. Systematic overview and meta-analysis of randomized trials.
J Am Coll Cardiol, 44 (2004), pp. 349-356
M. Sabate, A. Cequier, A. Iñiguez, A. Serra, R. Hernandez-Antolin, V. Mainar, et al.
Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial.
Lancet, 380 (2012), pp. 1482-1490
G. Ndrepepa, P.B. Berger, J. Mehilli, M. Seyfarth, F.J. Neumann, A. Schomig, et al.
Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions. Appropriateness of including bleeding as a component of a quadruple end-point.
J Am Coll Cardiol, 51 (2008), pp. 690-697
D.E. Cutlip, S. Windecker, R. Mehran, A. Boam, D.J. Cohen, G.A. Van Es, Academic Research Consortium, et al.
Clinical end points in coronary stent trials: a case for standardized definitions.
Circulation, 115 (2007), pp. 2344-2351
J.H. Chesebro, G. Knatterud, R. Roberts, J. Borer, L.S. Cohen, J. Dalen, et al.
Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge.
Circulation, 76 (1987), pp. 142-154
M. Hamon, L.H. Rasmussen, S.V. Manoukian, A. Cequier, M.A. Lincoff, H.J. Rupprecht, et al.
Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the ACUITY trial.
Eurointervention, 5 (2009), pp. 115-120
M.W. Klutstein, C.M. Westerhout, P.W. Armstrong, R.P. Giugliano, B.S. Lewis, C.M. Gibson, et al.
Radial versus femoral access, bleeding and ischemic events in patients with non-ST elevation acute coronary syndrome managed with an invasive strategy.
Am Heart J, 165 (2013), pp. 583-590
D.N. Feldman, R.V. Swaminathan, L.A. Kaltenbach, D.V. Baklanov, L.K. Kim, S.C. Wong, et al.
Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention. An updated report from National Cardiovascular Registry (2007-2012).
Circulation, 127 (2013), pp. 2295-2306
O. Barthélémy, J. Silvain, D. Brieger, A. Mercadier, R. Lancar, A. Bellemain-Appaix, et al.
Bleeding complications in primary percutaneous coronary intervention of ST-elevation myocardial infarction in a radial center.
Catheter Cardiovasc Interv, 79 (2012), pp. 104-112
J. Salgado Fernández, R. Calviño Santos, J.M. Vázquez Rodríguez, N. Vázquez González, E. Vázquez Rey, R. Pérez Fernández, et al.
Coronariografía y angioplastia coronaria por vía radial: experiencia inicial y curva de aprendizaje.
Rev Esp Cardiol, 56 (2003), pp. 152-159
S.V. Rao, F.S. Ou, T.Y. Wang, M.T. Roe, R. Brindis, J.S. Rumsfled, et al.
Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiocascular Data Registry.
JACC Cardiovasc Interv, 1 (2008), pp. 379-386
EPIC investigators.
Use of monoclonal antibody directed against the platelet glycoprotein IIb/IIa receptor in high risk coronary angioplasty. The EPIC investigation.
N Engl J Med, 330 (1994), pp. 956-961
M. De Carlo, G. Borelli, R. Gistri, N. Ciabatti, A. Mazzoni, M. Arena, et al.
Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes.
Catheter Cardiovasc Interv, 74 (2009), pp. 408-415
J. Eichhöfer, E. Horlick, J. Ivanov, P.H. Seidelin, J.R. Ross, D. Ing, et al.
Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience.
Am Heart J, 56 (2008), pp. 864-870
O.F. Bertrand, S.V. Rao, S. Pancholy, S.S. Jolly, J. Rodés Cabau, E. Larose, et al.
Transradial approach for coronary angiography and interventions results of the first international transradial practice survey.
JACC Cardiovasc Interv, 3 (2010), pp. 1022-1031
S. Jolly, S. Yusuf, J. Cairns, K. Niemela, D. Xavier, P. Widimsky, RIVAL trial group, et al.
Radial versus femoral access for coronary angiography and intervention in patients with acute syndromes (RIVAL): a randomised, parallel group, multicentre trial.
Lancet, 377 (2011), pp. 1409-1420
E. Romagnoli, G. Biondi-Zoccai, A. Sciahbasi, L. Politi, S. Rigattieri, G. Pendenza, et al.
Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome. The RIFLE-STEACS (Radial versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.
J Am Coll Cardiol, 60 (2012), pp. 2481-2489
S.R. Mehta, S.S. Jolly, J. Cairns, K. Niemela, S.V. Rao, A.N. Cheema, RIVAL Investigators, et al.
Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation.
J Am Coll Cardiol, 60 (2012), pp. 2490-2499
M.A. Mamas, K. Ratib, H. Routledge, F. Fath-Ordoubadi, L. Neyses, Y. Loubad, et al.
Influence of access site on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials.
Copyright © 2014. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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