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1. THE PREVALENCE AND OUTCOMES OF TRANSRADIAL PERCUTANEOUS CORONARY INTERVENTION FOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION:Analysis from the NCDR® (2007-2011) Dmitri V. Baklanov MD,Lisa A. Kaltenbach MS, Steven P. Marso MD, SumeetSubherwal MD, Dmitriy N. Feldman MD, Kirk Garratt MD, Jeptha Curtis MD, John Messenger MD, Sunil V. Rao MD

2. Funding Support and Disclaimer This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this presentation represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com.

3. Disclosure None

4. Background • Transradial PCI is associated with reduced risk of bleeding and vascular complications, as compared with femoral access PCI • Studies have suggested that TRI may reduce mortality among patients with STEMI • The rate of use of radial access for STEMI PCI in the U.S. is unknown

5. Objective To examine use and describe outcomes of radial access for percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)

6. 294,769 patients undergoing PCI for STEMI at 1204 hospitals in the CathPCI Registry® Patients were grouped according to access site used for PCI To minimize confounding, an inverse probability weighting analysis incorporating propensity scores was used Methods

7. Statistical Analysis Temporal Trends Outcomes Logistic regression with generalized estimating equations to account for within hospital clustering Propensity score to adjust for confounding by inverse probability of treatment weighting method • Quarterly proportion of TRI cases out of all PCI for STEMI

8. 2,673,218 PCI admissions at 1315 sites performed between 1/2007 and 10/2011 CONSORT DIAGRAM • Exclude if non STEMI PCI and PCI with >24 hrs of symptom onset • 356,425 admissions • Exclude if brachial access • 354,865 admissions • Exclude if non-acute PCI • 350,019 admissions • Exclude if cardiogenic shock • 313,838 admissions • Exclude if multiple PCI per hospital stay • 295,999 admissions • Exclude if missing data to calculate bleeding risk • 295,892 admissions • Exclude if a site has fewer than 10 PCI per year • 294,769 admissions at 1204 sites used for temporal trends analysis • Exclude v.3 of CathPCI Registry • 158,547 admissions • Exclude sites with no TRI • Final study population 90,879 admissions at 541 sites

9. Patient Characteristics

10. Endpoints • Primary • In-hospital mortality • Secondary • Procedural success • Bleeding

11. Results

12. Procedure Characteristics

13. Temporal Trends in TRI for STEMI 2007 2008 2009 2010 2011 Q1 Q2 Q3 Q1 Q1 Q1 Q1 Q2 Q2 Q2 Q2 Q3 Q3 Q3 Q3 Q4 Q4 Q4 Q4

14. Variability of TRI Use in STEMI

15. Pre- and Post- IPTW Balance of the Covariates

16. Pre- and Post- IPTW Balance of the Covariates

17. Association Between Radial vs. Femoral Access and Outcomes

18. Study Limitations • Association with outcomes cannot prove causality • Unmeasured confounding can be present • Events could be underreported • Outcomes are not adjudicated

19. Conclusions • Use of radial access for PCI in STEMI has increased over the study period • Despite longer door-to-balloon times, radial approach was associated with reduced in-hospital bleeding and mortality • These data support a need for an adequately powered randomized trial of TRI in STEMI