• Vicens Marti, Salvatore Brugaletta, Joan García-Picart, Guillermo Delgado, Angel Cequier, Andrés Iñiguez, Rosana Hernandez-Antolin, Patrick Serruys, Antonio Serra, Manel Sabaté, and investigators of the Examination study.
• Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain.
• Rev Esp Cardiol (Engl Ed). 2015 Jan 1; 68 (1): 47-53.

Introduction And ObjectivesInvasive 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.MethodsAn 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.ResultsFemoral 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).ConclusionsIn patients with ST-segment elevation acute myocardial infarction, the radial approach is an effective technique that improves prognosis and reduces bleeding complications.Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

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