Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial

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We sought to determine whether a transradial (TR) approach compared with a transfemoral (TF) approach was associated with improved clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in a post hoc analysis of the HORIZONS-AMI trial. There is a paucity of data comparing the TR approach with the TF approach in patients with STEMI treated with primary PCI and contemporary anticoagulant regimens. In HORIZONS-AMI, primary PCI for STEMI was performed in 3,340 patients, either by the TR (n=200) or TF approach (n=3,134). Endpoints included the 30-day and one-year rates of major adverse cardiovascular events (MACE: death, reinfarction, stroke or target vessel revascularisation), non CABG-related major bleeding, and net adverse clinical events (NACE: MACE or major bleeding). TR compared to TF access was associated with significantly lower 30-day rates of composite death or reinfarction (1.0% vs. 4.3%, OR 0.23, 95% CI [0.06,0.94], p=0.02), non CABG-related major bleeding (3.5% vs. 7.6%, OR 0.45, 95% CI [0.21,0.95], p=0.03), MACE (2.0% vs. 5.6%, OR 0.35, 95% CI [0.13,0.95], p=0.02), and NACE (5.0% vs. 11.6%,OR 0.42, 95% CI [0.22,0.78], p<0.01). At one year, the TR group still had significantly reduced rates of death or reinfarction (4.0% vs. 7.8%, OR 0.51, 95% CI [0.25,1.02], p=0.05), non CABG-related major bleeding (3.5% vs. 8.1%, OR 0.42, 95% CI [0.20,0.89], p=0.02), MACE (6.0% vs. 12.4%, OR 0.47, 95% CI [0.26,0.83], p<0.01) and NACE (8.5% vs. 17.8%, OR 0.45, 95% CI [0.28,0.74], p<0.001). By multivariable analysis, TR access was an independent predictor of freedom from MACE and NACE at 30 days and one year. In patients with STEMI undergoing primary PCI with contemporary anticoagulation regimens in the HORIZONS-AMI trial, a TR compared with a TF approach was associated with reduced major bleeding and improved event-free survival.