SAFE-PCI for Women

• Primary Efficacy Endpoint: Composite of BARC Types 2, 3, and 5 bleeding or vascular complications. [ Time Frame: From first arterial access post-randomization to 72 hours or hospital discharge, whichever occurs first. ] [ Designated as safety issue: Yes ]
• Primary Feasibility Endpoint: Procedural failure, defined as inability to complete the procedure from the assigned vascular access site. [ Time Frame: From first arterial access post-randomization to 72 hours or hospital discharge, whichever occurs first. ] [ Designated as safety issue: Yes ]

• Primary Efficacy Endpoint: Composite of BARC Types 2, 3, and 5 bleeding or vascular complications. [ Time Frame: Within 72 hours post-procedure or hospital discharge, whichever occurs first. ] [ Designated as safety issue: Yes ]
• Primary Feasibility Endpoint: Procedural failure, defined as inability to complete the procedure from the assigned vascular access site. [ Time Frame: Within 72 hours post-procedure or hospital discharge, whichever occurs first. ] [ Designated as safety issue: Yes ]

The hypothesis of the SAFE-PCI for women trial is that, compared with transfemoral PCI, transradial PCI will result in a significant reduction in bleeding and vascular complications. The primary objective is to compare the efficacy and feasibility of the transradial approach to percutaneous coronary intervention (PCI) in women compared with the transfemoral approach.

This study is a multicenter, randomized, open-label active controlled study. Three thousand women undergoing urgent or elective PCI from at least 50 centers will be randomized to either transradial or transfemoral PCI. Patients who are enrolled at sites performing ad hoc PCI will be randomized before diagnostic angiography. A total of approximately 3000 women will be randomized to obtain a cohort of approximately 1800 patients undergoing PCI.

• Percutaneous Coronary Intervention
• Ischemic Symptoms

• Procedure: Transradial PCI
  Transradial PCI
• Procedure: Transfemoral PCI
  Transfemoral PCI

• Transradial PCI
  Intervention: Procedure: Transradial PCI
• Transfemoral PCI
  Intervention: Procedure: Transfemoral PCI

Inclusion Criteria:

• Have the capacity to understand and sign an informed consent form
• Age ≥ 18 years
• Female patient undergoing urgent or elective PCI or undergoing diagnostic angiography to evaluate ischemic symptoms with the possibility of PCI

Exclusion Criteria:

• Peripheral arterial disease that prohibits vascular access
• Bilateral abnormal Barbeau tests
• Hemodialysis access (arteriovenous fistula or graft) in the arm to be used for PCI in case of assignment to radial approach (note that the opposite arm may be used for radial access in case a dialysis graft is present in one arm provided that the opposite arm has a normal Barbeau test)
• International normalized ratio (INR) ≥ 1.5 in a patient treated with oral vitamin K antagonists (i.e., warfarin).
• Receipt of oral Factor Xa or IIa inhibitors ≤ 24 hours prior to the procedure
• Planned staged PCI within 30 days of index procedure
• Valvular heart disease requiring valve surgery
• Planned right-heart catheterization
• Primary PCI for ST-segment elevation myocardial infarction
• Presence of bilateral internal mammary artery coronary bypass grafts
• Unable to provide informed consent
• Participation in any investigational drug or device study currently or within 30 days prior to enrollment