RIFLE-STEACS Finds Radial Access May Be Preferable for Angioplasty

November 10, 2011—Using the transradial approach for angioplasty in patients with ST-segment elevation acute coronary syndrome is preferable to the femoral approach and should be the recommended access route, according to conclusions of the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) trial that were presented in San Francisco at the annual Transcatheter Cardiovascular Therapeutics scientific symposium, which is sponsored by the Cardiovascular Research Foundation (CRF).

In announcing the presentation, CRF noted that bleeding complications in patients with acute coronary syndrome are a significant predictor of mortality, and recent data suggest that in these patients, the radial approach could be associated with improved mortality and morbidity.

As detailed by the CRF, the RIFLE-STEACS investigators sought to determine whether transradial access for STEACS treatment is associated with better outcomes when compared to transfemoral approach. The study was a prospective, randomized, parallel group, multicenter trial. Before arterial stick for percutaneous access, all STEACS patients eligible for acute revascularization were randomized (1:1 ratio) to radial or femoral access. The study enrolled 1,001 STEMI patients between January 2009 and July 2011 in four high-volume clinical sites in Italy.

The CRF reported that the study's primary endpoint was the 30-day rate of net adverse clinical events (NACE), a composite of cardiac death, myocardial infarction, stroke, target lesion revascularization, or noncoronary artery bypass graft–related major bleeding. Secondary endpoints were individual components of NACE.

The investigators found that at 30 days, the rate of NACE was significantly lower in the radial group versus the femoral group (13.6% vs 21%). This difference was determined by a reduction of both the major adverse cardiac and cerebrovascular events, (7.2% vs 11.4%) and of bleeding (7.8% vs 12.2%). In particular, the rate of cardiac death at 30 days was 9.2% in the femoral group and 5.2% in the radial group.

“Radial access in patients with ST elevation acute coronary syndrome is associated with significant clinical benefits, in terms of both lower morbidity and mortality,” commented Enrico Romagnoli, MD. “The radial approach should no longer just be considered a valid alternative to the femoral one but become the recommended access site for ST-elevation acute coronary syndrome.”