Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction

The HORIZONS-AMI trial

Philippe Genereux, Roxana Mehran, Tullio Palmerini, Adriano Caixeta, Ajay J. Kirtane, Alexandra J. Lansky, Bruce R. Brodie, Bernhard Witzenbichler, Martin Mockel, Giulio Guagliumi, Jan Z. Peruga, Dariusz Dudek, Martin P. Fahy, George Dangas, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Aims: 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. Methods and results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)905-916
Number of pages12
JournalEuroIntervention
Volume7
Issue number8
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

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Angioplasty
Percutaneous Coronary Intervention
Myocardial Infarction
Hemorrhage
Mortality
Anticoagulants
Disease-Free Survival
Stroke
ST Elevation Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Mehran, Roxana ; Palmerini, Tullio ; Caixeta, Adriano ; Kirtane, Ajay J. ; Lansky, Alexandra J. ; Brodie, Bruce R. ; Witzenbichler, Bernhard ; Mockel, Martin ; Guagliumi, Giulio ; Peruga, Jan Z. ; Dudek, Dariusz ; Fahy, Martin P. ; Dangas, George ; Stone, Gregg W. / Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction : The HORIZONS-AMI trial. In: EuroIntervention. 2011 ; Vol. 7, No. 8. pp. 905-916.
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title = "Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: The HORIZONS-AMI trial",
abstract = "Aims: 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. Methods and results: 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. Conclusions: 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.",
author = "Philippe Genereux and Roxana Mehran and Tullio Palmerini and Adriano Caixeta and Kirtane, {Ajay J.} and Lansky, {Alexandra J.} and Brodie, {Bruce R.} and Bernhard Witzenbichler and Martin Mockel and Giulio Guagliumi and Peruga, {Jan Z.} and Dariusz Dudek and Fahy, {Martin P.} and George Dangas and Stone, {Gregg W.}",
year = "2011",
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doi = "10.4244/EIJV7I8A144",
language = "English (US)",
volume = "7",
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Genereux, P, Mehran, R, Palmerini, T, Caixeta, A, Kirtane, AJ, Lansky, AJ, Brodie, BR, Witzenbichler, B, Mockel, M, Guagliumi, G, Peruga, JZ, Dudek, D, Fahy, MP, Dangas, G & Stone, GW 2011, 'Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: The HORIZONS-AMI trial', EuroIntervention, vol. 7, no. 8, pp. 905-916. https://doi.org/10.4244/EIJV7I8A144

Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction : The HORIZONS-AMI trial. / Genereux, Philippe; Mehran, Roxana; Palmerini, Tullio; Caixeta, Adriano; Kirtane, Ajay J.; Lansky, Alexandra J.; Brodie, Bruce R.; Witzenbichler, Bernhard; Mockel, Martin; Guagliumi, Giulio; Peruga, Jan Z.; Dudek, Dariusz; Fahy, Martin P.; Dangas, George; Stone, Gregg W.

In: EuroIntervention, Vol. 7, No. 8, 01.12.2011, p. 905-916.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction

T2 - The HORIZONS-AMI trial

AU - Genereux, Philippe

AU - Mehran, Roxana

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Kirtane, Ajay J.

AU - Lansky, Alexandra J.

AU - Brodie, Bruce R.

AU - Witzenbichler, Bernhard

AU - Mockel, Martin

AU - Guagliumi, Giulio

AU - Peruga, Jan Z.

AU - Dudek, Dariusz

AU - Fahy, Martin P.

AU - Dangas, George

AU - Stone, Gregg W.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Aims: 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. Methods and results: 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. Conclusions: 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.

AB - Aims: 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. Methods and results: 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. Conclusions: 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.

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