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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/26468

Title: Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation
Authors: Vranckx, Pascal
Frigoli, Enrico
Rothenbuhler, Martina
Tomassini, Francesco
Garducci, Stefano
Ando, Giuseppe
Picchi, Andrea
Sganzerla, Paolo
Paggi, Anita
Ugo, Fabrizio
Ausiello, Arturo
Sardella, Gennaro
Franco, Nicoletta
Nazzaro, Marco
de Cesare, Nicoletta
Tosi, Paolo
Falcone, Camillo
Vigna, Carlo
Mazzarotto, Pietro
Di Lorenzo, Emilio
Moretti, Claudio
Campo, Gianluca
Penzo, Carlo
Pasquetto, Giampaolo
Heg, Dik
Juni, Peter
Windecker, Stephan
Valgimigli, Marco
Issue Date: 2017
Citation: EUROPEAN HEART JOURNAL, 38(14), p. 1069-1080
Abstract: Aims To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) Methods and results In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [ rate ratio (RR) = 0.96, 95% CI = 0.75-1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67-0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68-1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69-0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively) Conclusion Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation.
URI: http://hdl.handle.net/1942/26468
DOI: 10.1093/eurheartj/ehx048
ISI #: 000398576800013
ISSN: 0195-668X
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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