IJCS | Volume 32, Nº2, March/April 2019

129 Figure 1 - Changes in clinical practice after the RIVAL (2011), TASTE (2013) and TOAST (2014) studies . Machado et al. Care changes in primary PCI Int J Cardiovasc Sci. 2019;32(2)125-133 Original Article years of age. 10,11 Other comorbidities remained stable during the study period. Recently, new evidence suggests that primary PCI should be performed through radial access due to a significant mortality reduction and lower occurrence of adverse cardiac events. In the largest comparative study between the access routes, the randomized and multicenter trial RIVAL 4 (Radial Versus Femoral Access for Coronary Intervention), patients with STEMI who underwent primary PCI through radial access had lower mortality rates (1.3 versus 3.2%, p = 0.006) and lower rates of death, infarction and stroke (2.7 versus 4.6%, p = 0.03) at 30 days when compared to those who underwent primary PCI through femoral access. In fact, due to the consistency of these findings, international guidelines 12,13 recommend that the radial access be preferred in situations of STEMI. The data found in our study confirm the changes observed in clinical practice after the publications and highlight a consistency of practice with the current guidelines changes by a significant replacement of the radial access by the femoral access. When compared in the present study, the radial access showed lower mortality and adverse events in relation to the femoral access, corroborating the literature data, although a significant mortality reduction over the 6-year period was not demonstrated in our service (p trend < 0.001 for all comparisons) . Another important data from the analysis was the significant reduction in the performance of aspiration thrombectomy. The rates, which were 82.1% in 2012 decreased progressively after the publication of the TASTE 6 study, which suggested the non-effectiveness of the device as an adjunct treatment to primary PCI. After these data were published, routine aspiration thrombectomy reached rates of less than 3.0% in 2016. In 2014, the TOTAL 3 study was published, which showed an increase in stroke rates (0.7 vs. 0.3%, p = 0.02) without reducing other outcomes, leading to changes in the current guidelines regarding indications for routine aspiration thrombectomy 14 and corroborating the discontinuity of this technique as a routine procedure in our service. The use of DES increased after their selective reimbursement by the Brazilian public healthcare system, which occurred in August 2014. Thus, there was a significant increase in their use in our registry, reaching 25.0% in 2016. The use of DES is associatedwith a decrease in repeated target vessel revascularization