{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:07:13Z","timestamp":1777576033043,"version":"3.51.4"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,6,13]]},"abstract":"\n Background<\/jats:title>\n \n The effectiveness of radial access (\n RA<\/jats:styled-content>\n ) in\n ST<\/jats:styled-content>\n \u2010elevation myocardial infarction (\n STEMI<\/jats:styled-content>\n ) has been predominantly established in primary percutaneous coronary intervention (\n pPCI<\/jats:styled-content>\n ) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of\n RA<\/jats:styled-content>\n versus femoral (\n FA<\/jats:styled-content>\n ) access in\n STEMI<\/jats:styled-content>\n undergoing either a pharmacoinvasive (\n PI<\/jats:styled-content>\n ) strategy or\n pPCI<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Within\n ST<\/jats:styled-content>\n rategic Reperfusion Early After Myocardial Infarction (\n STREAM<\/jats:styled-content>\n ), we evaluated the relationship between arterial access site and primary outcome (30\u2010day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820\n STEMI<\/jats:styled-content>\n patients were included: 895\n PI<\/jats:styled-content>\n (49.2%; rescue\n PCI<\/jats:styled-content>\n [n=379; 42.3%], scheduled\n PCI<\/jats:styled-content>\n [n=516; 57.7%]) and 925\n pPCI<\/jats:styled-content>\n (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site (\n FA<\/jats:styled-content>\n :\n PI<\/jats:styled-content>\n 53.4% and\n pPCI<\/jats:styled-content>\n 57.6%).\n FA STEMI<\/jats:styled-content>\n patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more \u2211\n ST<\/jats:styled-content>\n \u2010elevation at baseline. The primary composite endpoint occurred in 8.9%\n RA<\/jats:styled-content>\n versus 15.7%\n FA<\/jats:styled-content>\n patients (\n P<\/jats:italic>\n <0.001). On multivariable analysis, this benefit on the primary composite outcome favoring\n RA<\/jats:styled-content>\n persisted (adjusted odds ratio [\n OR<\/jats:styled-content>\n ], 0.59; 95%\n CI<\/jats:styled-content>\n , 0.44\u20130.78;\n P<\/jats:italic>\n <0.001) and was evident in both\n pPCI<\/jats:styled-content>\n (adjusted\n OR<\/jats:styled-content>\n , 0.63; 95%\n CI<\/jats:styled-content>\n , 0.43\u20130.92) and\n PI<\/jats:styled-content>\n cohorts (adjusted\n OR<\/jats:styled-content>\n , 0.57 95%\n CI<\/jats:styled-content>\n , 0.37\u20130.86;\n P<\/jats:italic>\n interaction=0.730). There was no difference in nonintracranial major bleeding with either access group (\n RA<\/jats:styled-content>\n vs\n FA<\/jats:styled-content>\n , 5.2% vs 6.0%;\n P<\/jats:italic>\n =0.489).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Regardless of the application of a\n PI<\/jats:styled-content>\n or\n pPCI<\/jats:styled-content>\n strategy,\n RA<\/jats:styled-content>\n was associated with improved clinical outcomes, supporting current\n STEMI<\/jats:styled-content>\n evidence in favor of\n RA<\/jats:styled-content>\n in\n PCI<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00623623.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.003559","type":"journal-article","created":{"date-parts":[[2016,6,14]],"date-time":"2016-06-14T03:00:59Z","timestamp":1465873259000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Relationship Between Arterial Access and Outcomes in ST\u2010Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study"],"prefix":"10.1161","volume":"5","author":[{"given":"Jay","family":"Shavadia","sequence":"first","affiliation":[{"name":"Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Welsh","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Gershlick","sequence":"additional","affiliation":[{"name":"Department of Academic Cardiology, University Hospitals of Leicester, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinggan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigrun","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oslo University Hospital HF Ullev\u00e5l, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillipe G.","family":"Steg","sequence":"additional","affiliation":[{"name":"Sorbonne Paris\u2010Cit\u00e9, INSERM Unit\u00e9 1148, H\u00f4pital Bichat, Assistance Publique\u2010H\u00f4pitaux de Paris, Universit\u00e9 Paris\u2013Diderot, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frans","family":"Van de Werf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the STREAM Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","first-page":"14","article-title":"Radial versus femoral access for primary percutaneous interventions in ST\u2010segment elevation myocardial infarction patients: a meta\u2010analysis of randomized controlled trials","volume":"8","author":"Karrowni W","year":"2013","unstructured":"Karrowni W, Vyas A, Giacomino B, Schweizer M, Blevins A, Girotra S, Horwitz P. 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