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Heart, Lung and Circulation

Radial First in Primary Percutaneous Coronary Intervention—Ensuring At-Risk Groups Aren’t Left Behind

  • Shamus Toomath
    Affiliations
    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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  • Clare Arnott
    Correspondence
    Corresponding author at: The George Institute for Global Health, 1 King Street, Newtown, 2042 NSW, Australia.
    Affiliations
    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    The George Institute for Global Health, Sydney, NSW, Australia
    Search for articles by this author
  • Sanjay Patel
    Affiliations
    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    The George Institute for Global Health, Sydney, NSW, Australia

    The Heart Research Institute, Sydney, NSW, Australia
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      A decade ago, radial artery access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) represented less than 10% of procedures undertaken worldwide [
      • Arzamendi D.
      • Ly H.Q.
      • Tanguay J.F.
      • Chan M.Y.
      • Chevallereau P.
      • Gallo R.
      • et al.
      Effect on bleeding, time to revascularization, and one-year clinical outcomes of the radial approach during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
      ], with transfemoral access the most common route of procedural access. The landmark Radial Vs femorAL access for coronary angiography and intervention in acute coronary syndrome (ACS) patients (RIVAL) study, published in 2011, was instrumental in changing this paradigm of care. RIVAL demonstrated that radial access was associated with a significantly lower rate of vascular complications as compared to femoral access [
      • Jolly S.S.
      • Yusuf S.
      • Cairns J.
      • Niemelä K.
      • Xavier D.
      • Widimsky P.
      • et al.
      Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.
      ], a finding that has been subsequently confirmed in more recent studies demonstrating less bleeding and reduced mortality [
      • Mason P.J.
      • Shah B.
      • Tamis-Holland J.E.
      • Bittl J.A.
      • Cohen M.G.
      • Safirstein J.
      • et al.
      An Update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association.
      ,
      • Valgimigli M.
      • Frigoli E.
      • Leonardi S.
      • Vranckx P.
      • Rothenbühler M.
      • Tebaldi M.
      • et al.
      Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial.
      ]. The radial artery has thereafter gradually become the preferred mode of access for coronary angiography and angioplasty. In recognition of this, a 2018 Scientific Statement from the American Heart Association proposed a “radial-first” strategy in the United States for ACS patients. Current contemporary data reaffirms this shift with radial artery access used in up to 83% of ST-segment elevation myocardial infarction (STEMI) cases [
      • Dang D.
      • Dowling C.
      • Zaman S.
      • Cameron J.
      • Kuhn L.
      Predictors of radial to femoral artery crossover during primary percutaneous coronary intervention: a systematic review and meta-analysis.
      ].

      Key Words

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