The SAfety and efficacy of Femoral Access versus RadIal access for primary PCI in STEMI. (The SAFARI-STEMI trial)

Heart attacks remain of the leading causes of death in Canada. Sudden blockage of a blood vessel supplying nutrients to the heart is responsible for these life threatening heart attacks. Current medical practice considers angioplasty as the best procedure to open these blocked vessels. The procedure involves advancing a small catheter from the groin or the wrist to the heart. The catheter is used to inject due which shows the blockage responsible for the heart attack. The cardiologist then uses the catheter to introduce stents to fully reopen the blocked artery. A stent is a small mesh of metal left in the vessel acting as a scaffolding to ensure long standing success. The heart attack is terminated by successful restoration of blood flow to the heart.To improve survival and limit complications, the procedure has to be done quickly and efficiently. Traditionally, angioplasty for heart attacks has been done using the groin as the access point. The feasibility of performing the procedure via the wrist is now established. Wrist access may be safer because it is associated with less bleeding. There is also mounting evidence that bleeding may be associated with higher mortality. Indeed recent studies suggest that survival can be improved by wrist access. However, these studies were relatively small and not designed to demonstrate conclusively that survival is better. Furthermore, these studies did not include contemporary strategies shown to reduce bleeding and improve survival. Hence, many specialists continue to use the groin approach. SAFARI-STEMI is designed to include these novel strategies and aims to determine with certainty if the wrist approach confers a survival benefit. The study will also evaluate other outcomes such as bleeding, stroke, and recurrent heart attack. The SAFARI-STEMI trial is important as it will conclusively determine if the wrist approach provides a survival benefit; this will most likely influence worldwide practice guidelines.