Chapter 35: ST-Segment Elevation Myocardial Infarction (STEMI)

Less than 10% of percutaneous coronary interventions (PCI) in the ST-segment elevation myocardial infarction (STEMI) setting are performed via the radial approach. Current data suggests that radial artery access for primary PCI is safe, feasible, and possibly offers a mortality benefit in the STEMI setting (RIVAL and RIFLE-STEACS).

Subgroup analysis of STEMI patients in the RIVAL trial showed a 40% reduction in the primary endpoint (composite of death, non-lethal MI, stroke, or major bleeding not related to CABG) and a 41% reduction in the risk of death. The RIFLE-STEACS trial randomized 1,001 patients with STEMI to radial or femoral access for primary PCI and showed an absolute 4% reduction in 30-day BARC type 2 or greater bleeding and mortality with radial access.

The mortality benefit may be independent of the reduction in bleeding and possibly related to reduced hospital days and time spent in the CCU along with earlier ambulation.

Matthew Hann, MD and Sunil V. Rao, MD