Distal radial access to prevent radial artery occlusion for STEMI patients (RAPID III): a randomized controlled trial.

Abstract

Compared with conventional transradial access (TRA), distal radial access (DRA) is rarely used for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and may be beneficial to prevent radial artery occlusion (RAO). We aimed to evaluate the incidence of RAO between DRA and TRA 24 h after primary PCI in patients with STEMI. This is a single-center, open-label, prospective, randomized controlled trial conducted at Beijing Luhe Hospital, China, between January 2022 and July 2023. Five hundred and twenty patients (mean age: 61.3 ± 13.0 years; 81% male) with STEMI were randomly assigned to the DRA (n = 260) or TRA (n = 260) group. Primary PCI was performed using the radial artery access assigned study group. The primary endpoint was the rate of RAO assessed using Doppler ultrasound 24 h after primary PCI. Secondary outcomes included time taken for sheath insertion, access success rate, hemostasis time, fluoroscopy time, radiation dosage, and access-related complications. The incidence of RAO was significantly lower in the DRA group than that in the TRA group (1.9% vs. 8.5%, P = 0.001). Access was successful in 94.6% of patients, and the crossover rate was 5.4% in both groups. The median time taken for sheath insertion was significantly longer (133 s vs. 114 s, P = 0.009), whereas the mean hemostasis time was shorter (209 ± 71 min vs. 372 ± 70 min, P < 0.001) in the DRA group. The incidence of modified Early Discharge After Transradial Stenting of Coronary Arteries (mEASY) ≥ II hematoma was lower in the DRA group (0.8% vs. 3.5%, P = 0.033). However, there was no significant difference in fluoroscopy time, radiation dosage, or access-related complications. In patients with STEMI undergoing primary PCI, compared with TRA, DRA prevented RAO 24 h postoperatively and was associated with shorter hemostasis time and a lower incidence of mEASY ≥ II hematoma. Clinical Trials.gov Identifier: NCT05461781.