Background Primary Percutaneous Coronary Intervention (PPCI) through the radial artery is considered to be safer in the hands of operators, experienced in that approach. We examined the impact of radial and femoral access in the HEAT-PPCI trial.

Methods We compared the primary safety and efficacy outcomes* at 28 days, by final access site used (radial or femoral) and by default operator type. We then specifically assessed outcomes in femoral cases performed by both, default radial and femoral operators.

Findings 1804 cases were included in the final analysis. In a simple analysis, radial access was associated with significantly fewer MACE and bleeding events.* When analysed by default operator type, the incidence of MACE and bleeding events were similar.* In the femoral cases done by radial or femoral operators, MACE and bleeding events were significantly worse for the radial operators, potentially explained by less favourable baseline characteristics.*

Interpretation In this unselected, real-world population treated with PPCI, default femoral operators, when compared to high volume radial operators, achieved comparable MACE outcomes but at the expense of increased bleeding - mainly minor bleeding. The less favourable outcomes observed for femoral access in the whole population is probably due to its use by radial operators in high risk cases. *See Table

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Abstract 17 Table 1

Baseline characteristics, Primary efficacy and Safety outcomes (as defined in the HEAT—PPCI trial). SBP: Systolic Blood Pressure, eGFR:estimated Glomerular Filtration Rate, Ml: Myocardial Infarction, CABG: Coronary Artery Bypass Grafting, PCI: Percutaneous Coronary Intervention, GPI: Glycoprotein IIb/IIIa inhibitor, MACE: Major Adverse Cardiovascular Events