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Comment & Response
September 2, 2020

Residual Challenges in Radial Approach for Percutaneous Coronary Interventions

Author Affiliations
  • 1HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
JAMA Cardiol. 2020;5(12):1451. doi:10.1001/jamacardio.2020.3687

To the Editor We read with interest the article by Le May et al1 comparing radial and femoral approaches in patients with ST-elevation myocardial infarction (the SAFARI-STEMI trial). However, we believe that a detailed per-treatment analysis, mainly focused on bleeding, would be of major importance. In fact, data from the Radial vs Femoral Access for Coronary Intervention (RIVAL) trial2 showed that all major bleeding occurring in the radial group were, in reality, femoral complications. If similar results were confirmed in the SAFARI-STEMI trial,1 it would become evident that the necessary step to achieve relevant clinical benefits with the radial approach is that of minimizing crossover. Indeed, crossover from radial to femoral approach occurred in 8.1% of the cases in the SAFARI-STEMI trial1 and in 7.6% in the RIVAL trial.2 We understand these are real-life data, and the intention-to-treat analysis is the correct primary way to assess results of the trial. However, a per-treatment analysis would put these data in perspective. If we were able to reduce this crossover to much lower figures,3 this would have the potential to lead to the expected major clinical benefits using the radial approach, potentially abolishing major access site–related bleeding and maybe leading to the postulated mortality benefit. To minimize crossover to femoral approach, several measures can be adopted:

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