Conventional vs. Distal Radial Access Outcomes in STEMI Patients Treated by PCI

NCT ID: NCT06013813

Last Updated: 2023-11-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

2922 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-07

Study Completion Date

2025-02-01

Brief Summary

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This clinical trial aims to compare conventional radial access versus distal radial access in patients with STEMI undergoing PCI. The main question it aims to answer is:

• Mayor adverse cardiac events (MACE) at 30 days in STEMI patients treated by PCI are not inferior when comparing the distal radial approach versus the conventional radial approach ?

Participants will:

* sign the informed consent to enroll in the clinical trial.
* will agree to be treated by PCI
* will be randomized 1:1 to perform PCI by conventional radial or distal radial approach.

If there is a comparison group:

Researchers will compare conventional radial access vs distal radial access to see if the distal approach is not inferior compared to the conventional radial access in order to offer less or equal MACE and a similar rate of a successful procedure.

Detailed Description

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Conditions

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STEMI - ST Elevation Myocardial Infarction Myocardial Infarction Acute Coronary Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Distal radial approach

* Clean and dry the puncture site.
* Simple lidocaine 2% is infiltrated.
* The artery is punctured in the radial distal zone, and a 6 Fr hydrophilic radial introducer is placed with the Seldinger technique.
* Verapamil 2.5 mg and Heparin 5000 IU are administered.
* PCI is performed.
* Finally, the introducer is withdrawn with the patent hemostasis technique, and a radial compression device is placed (prelude mostly or terumo).

Group Type EXPERIMENTAL

Radial Artery approach on percutaneous coronary intervention (PCI)

Intervention Type PROCEDURE

* Randomized patients with a right patent radial artery.
* The outcomes of the distal radial approach will be compared with those of the conventional radial approach.
* Technique and devices (introducer and compression devices) are the same in both approaches.

Conventional radial approach (proximal radial approach).

* Clean and dry the puncture site.
* Simple lidocaine 2% is infiltrated.
* The artery is punctured in the radial proximal zone, and a 6 Fr hydrophilic radial introducer is placed with the Seldinger technique.
* Verapamil 2.5 mg and Heparin 5000 IU are administered.
* PCI is performed.
* Finally, the introducer is withdrawn with the patent hemostasis technique, and a radial compression device is placed (terumo).

Group Type ACTIVE_COMPARATOR

Radial Artery approach on percutaneous coronary intervention (PCI)

Intervention Type PROCEDURE

* Randomized patients with a right patent radial artery.
* The outcomes of the distal radial approach will be compared with those of the conventional radial approach.
* Technique and devices (introducer and compression devices) are the same in both approaches.

Interventions

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Radial Artery approach on percutaneous coronary intervention (PCI)

* Randomized patients with a right patent radial artery.
* The outcomes of the distal radial approach will be compared with those of the conventional radial approach.
* Technique and devices (introducer and compression devices) are the same in both approaches.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* STEMI patients underwent PCI.
* Patent radial access (distal and conventional)
* Patients who agree to participate in the study and sign the informed consent form.

Exclusion Criteria

* Cardiogenic shock.
* Previous coronary artery bypass grafting (CABG).
* Absence of palpable radial pulse.
* Arteriovenous fistula for hemodialysis.
* Previous radial artery occlusion.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto Nacional de Cardiologia Ignacio Chavez

OTHER

Sponsor Role lead

Responsible Party

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Guering Eid Lidt

Director of Cardiac Catheterization Lab

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guering Eid Lidt, PhD

Role: STUDY_CHAIR

Guering Eid-Lidt

Locations

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Instituto Nacional de Cardiología Ignacio Chávez

Mexico City, , Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Juan Carlos Plata Corona, PhD

Role: CONTACT

+522212187940

Guering Eid Lidt, PhD

Role: CONTACT

+525585803787

Facility Contacts

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Carlos Plata

Role: primary

+55 2212187940

References

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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC; American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; and Council on Genomic and Precision Medicine. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv. 2018 Sep;11(9):e000035. doi: 10.1161/HCV.0000000000000035.

Reference Type BACKGROUND
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Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, Fraser DG, Hildick-Smith D, de Belder M, Ludman PF, Nolan J; British Cardiovascular Intervention Society; National Institute for Cardiovascular Outcomes Research. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol. 2014 Oct 14;64(15):1554-64. doi: 10.1016/j.jacc.2014.05.075.

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Ferrante G, Rao SV, Juni P, Da Costa BR, Reimers B, Condorelli G, Anzuini A, Jolly SS, Bertrand OF, Krucoff MW, Windecker S, Valgimigli M. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016 Jul 25;9(14):1419-34. doi: 10.1016/j.jcin.2016.04.014. Epub 2016 Jun 29.

Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Mehta SR, Jolly SS, Cairns J, Niemela K, Rao SV, Cheema AN, Steg PG, Cantor WJ, Dzavik V, Budaj A, Rokoss M, Valentin V, Gao P, Yusuf S; RIVAL Investigators. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol. 2012 Dec 18;60(24):2490-9. doi: 10.1016/j.jacc.2012.07.050. Epub 2012 Oct 24.

Reference Type BACKGROUND
PMID: 23103036 (View on PubMed)

Ferrante G, Condello F, Rao SV, Maurina M, Jolly S, Stefanini GG, Reimers B, Condorelli G, Lefevre T, Pancholy SB, Bertrand O, Valgimigli M. Distal vs Conventional Radial Access for Coronary Angiography and/or Intervention: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2022 Nov 28;15(22):2297-2311. doi: 10.1016/j.jcin.2022.09.006.

Reference Type BACKGROUND
PMID: 36423974 (View on PubMed)

Eid-Lidt G, Rivera Rodriguez A, Jimenez Castellanos J, Farjat Pasos JI, Estrada Lopez KE, Gaspar J. Distal Radial Artery Approach to Prevent Radial Artery Occlusion Trial. JACC Cardiovasc Interv. 2021 Feb 22;14(4):378-385. doi: 10.1016/j.jcin.2020.10.013.

Reference Type BACKGROUND
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Bernat I, Aminian A, Pancholy S, Mamas M, Gaudino M, Nolan J, Gilchrist IC, Saito S, Hahalis GN, Ziakas A, Louvard Y, Montalescot G, Sgueglia GA, van Leeuwen MAH, Babunashvili AM, Valgimigli M, Rao SV, Bertrand OF; RAO International Group. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper. JACC Cardiovasc Interv. 2019 Nov 25;12(22):2235-2246. doi: 10.1016/j.jcin.2019.07.043.

Reference Type BACKGROUND
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Reference Type BACKGROUND
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Aminian A, Sgueglia GA, Wiemer M, Kefer J, Gasparini GL, Ruzsa Z, van Leeuwen MAH, Ungureanu C, Leibundgut G, Vandeloo B, Kedev S, Bernat I, Ratib K, Iglesias JF, Al Hage E, Posteraro GA, Pascut D, Maes F, Regazzoli D, Kakonyi K, Meijers TA, Colletti G, Krivoshei L, Lochy S, Zafirovska B, Horak D, Nolan J, Degrauwe S, Tobita K, Saito S. Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial. JACC Cardiovasc Interv. 2022 Jun 27;15(12):1191-1201. doi: 10.1016/j.jcin.2022.04.032. Epub 2022 May 17.

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Reference Type RESULT
PMID: 30165437 (View on PubMed)

Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS Jr, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-e129. doi: 10.1016/j.jacc.2021.09.006. Epub 2021 Dec 9.

Reference Type RESULT
PMID: 34895950 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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23-1367

Identifier Type: -

Identifier Source: org_study_id

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