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Femoral Versus Radial Access for Primary PCI (SAFARI-STEMI)

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ClinicalTrials.gov Identifier: NCT01398254
Recruitment Status : Completed
First Posted : July 20, 2011
Last Update Posted : January 29, 2019
Information provided by (Responsible Party):
Michel Le May, Ottawa Heart Institute Research Corporation

Brief Summary:

Primary percutaneous coronary intervention (PPCI) has become the dominant strategy for the treatment of ST-elevation myocardial infarction (STEMI), as studies have shown that PPCI is superior to fibrinolytic therapy. Recent evidence suggests that transradial access (TRA) is superior to transfemoral (TFA) for patients undergoing PPCI. Two large trials report a mortality benefit favouring TRA. The results of these two trials could significantly impact practice guidelines and lead to a recommendation that the approach of choice for primary PCI be radial rather than femoral. This would have significant implications for both PCI centers and interventionalists associated with a large impact on practice and education. Yet, many centers and interventionalists in Canada and in the USA prefer TFA and currently feel pressured in making the change to TRA. With that said, these trials did not include new pharmacotherapy and new technology that would likely have closed or eliminated the gap between TFA and TRA by improving the safety and efficacy of these two approaches. Furthermore, these trials were not powered to conclusively show a mortality benefit. The authors of the two large trials emphasized the need for further trials to confirm the benefits of TRA.

The SAFARI-STEMI trial aims to compare TFA with TRA in patients undergoing primary percutaneous intervention (PPCI). The primary outcome will be defined as all cause mortality measured at 30 days. The trial will also evaluate: 1) bleeding events and 2) the composite of death, reinfarction, or stroke defined as major adverse clinical events (MACE). The trial will include the use of antithrombotic therapy with monotherapy, with either bivalirudin or unfractionated heparin; the use of glycoprotein inhibitors IIb/IIIa inhibitors will be avoided. The study will encourage liberal use of vascular closing devices. The trial will also compare delays to reperfusion between the two strategies. Finally, a cost analysis is proposed.

In view of recent publications, there is now a need for a large randomized trial using contemporary adjunct therapies to assess the safety and efficacy of the TRA vs. the TFA in PPCI. The proposed trial aims to conclusively show whether there is a survival benefit associated with the TRA approach.

Condition or disease Intervention/treatment Phase
Myocardial Infarction STEMI Procedure: Primary Percutaneous Coronary Intervention (PPCI) Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 2292 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: The Safety and Efficacy of Femoral Access Versus Radial for Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (SAFARI-STEMI Trial)
Study Start Date : July 2011
Actual Primary Completion Date : December 2018
Actual Study Completion Date : January 16, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Attack

Arm Intervention/treatment
Transradial Access
Procedure: Primary Percutaneous Coronary Intervention (PPCI)
Participants will be randomly assigned an access site, radial or femoral, for PPCI.

Transfemoral Access
Procedure: Primary Percutaneous Coronary Intervention (PPCI)
Participants will be randomly assigned an access site, radial or femoral, for PPCI.

Primary Outcome Measures :
  1. All-cause mortality [ Time Frame: 30 days ]
    The primary outcomes will be all-cause mortality measured at 30 days.

Secondary Outcome Measures :
  1. Death, reinfarction, or stroke [ Time Frame: 30 days and 6 months ]
  2. All-cause mortality [ Time Frame: 6 months ]
  3. Reinfarction [ Time Frame: 30 days and 6 months ]
  4. Stroke [ Time Frame: 30 days and 6 months ]
  5. Stent thrombosis [ Time Frame: 30 days and 6 months ]
  6. Bleeding [ Time Frame: 30 days ]
  7. Number of blood transfusions [ Time Frame: 30 days ]
  8. Cardiogenic shock [ Time Frame: 30 days ]
  9. Critical time intervals (including door-to-balloon time) [ Time Frame: Index hospitalization ]
  10. Fluoroscopy time and radiation exposure [ Time Frame: Index Catheterization ]
  11. Length of Hospital Stay [ Time Frame: Index hospitalization ]
  12. Resource utilization [ Time Frame: 30 days ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Ischemic chest discomfort of greater or equal to 30 minutes duration,
  2. Onset of chest pain of greater or equal to 12 hrs prior to entry into the study,
  3. ST segment elevation of > 1 mm (0.1 mV) in two or more contiguous electrocardiographic leads (on a standard 12 lead ECG) or left bundle branch block not known to be old

Exclusion Criteria:

  1. Age < 18 yrs
  2. Active bleeding
  3. Inadequate vascular access from the femoral arteries (i.e. severe peripheral vascular artery disease precluding right or left femoral approach)
  4. Abnormal Allen's test precluding either right or left radial approach
  5. PCI within the last 30 days
  6. Fibrinolytic agents within the last 7 days
  7. Warfarin, dabigatran or other oral anticoagulant within the last 7 days
  8. Known coagulation disorder (i.e. INR >2.0, platelets <100,000 / mm3)
  9. Allergy to aspirin
  10. Participation in a study with another investigational device or drug < four weeks
  11. Known severe renal impairment (creatinine >200 umol/L)*
  12. Known severe contrast (dye) allergy
  13. Prior coronary artery bypass surgery
  14. Inability to provide informed consent

    • Bivalirudin is contraindicated in renal failure.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01398254

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Canada, Manitoba
St. Boniface Hospital
Winnipeg, Manitoba, Canada, R2H 2A6
Canada, New Brunswick
Saint John Regional Hospital
Saint John, New Brunswick, Canada, E2L 4L2
Canada, Nova Scotia
Queen Elizabeth II Health Sciences Center
Halifax, Nova Scotia, Canada, B3H 4G4
Canada, Ontario
University of Ottawa Heart Institute
Ottawa, Ontario, Canada, K1Y 4W7
Thunder Bay Regional Health Sciences Center
Thunder Bay, Ontario, Canada, P7B 6V4
Sponsors and Collaborators
Ottawa Heart Institute Research Corporation
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Principal Investigator: Michel R Le May, MD Ottawa Heart Institute Research Corporation
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Michel Le May, Director of Regional ACS Programs, Ottawa Heart Institute Research Corporation
ClinicalTrials.gov Identifier: NCT01398254    
Other Study ID Numbers: MRL-SS
First Posted: July 20, 2011    Key Record Dates
Last Update Posted: January 29, 2019
Last Verified: January 2019
Keywords provided by Michel Le May, Ottawa Heart Institute Research Corporation:
ST-Elevation Myocardial Infarction
Additional relevant MeSH terms:
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Myocardial Infarction
ST Elevation Myocardial Infarction
Pathologic Processes
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases