RADIAL VERSUS FEMORAL ACCESS FOR CORONARY ANGIOGRAPHY/INTERVENTION IN WOMEN WITH ACUTE CORONARY SYNDROMES: INSIGHTS FROM THE RIVAL TRIAL

Abstract

To determine the efficacy and safety of radial versus femoral access for coronary angiography/intervention in women in the RIVAL trial. Radial access is more challenging in women due to smaller radial arteries, possibly resulting in reduced procedural success. In a pre-specified RIVAL subgroup analysis, we compared outcomes in patients randomized to radial versus femoral access in women (N=1861). There was no difference in the primary composite endpoint of death, myocardial infarction, stroke, and non-CABG bleeding at 30 days in women (radial 3.96%; femoral 5.04%; HR 0.78; 95%CI 0.50-1.20; p=0.250), and men (radial 3.54%; femoral 3.55%; HR 0.99; 95%CI 0.74-1.33; p=0.971; p for interaction=0.356). Major vascular complications were significantly reduced with the radial access use (in women: radial 3.2%; femoral 6.2%; HR 0.51; 95%CI 0.33-0.81; p=0.003; in men: radial 0.77%; femoral 2.81%; HR 0.27; 95%CI 0.17-0.45; p<0.0001; p for interaction=0.064). Cross-over rates were higher with radial access in both women and men (women: HR 5.49; 95% CI 3.37-8.97; p<0.0001;men: HR 3.20; 95%CI 2.36-4.38; p<0.0001; p for interaction=0.063). PCI success rates were similar irrespective of access site (women: HR 1.03; 95%CI 0.91-1.16; p=0.686;men: HR 1.00; 95%CI 0.94-1.01; p=0.948; p for interaction = 0.808), with no differences in PCI complications. In a multivariable analysis, women versus men was an independent predictor of major vascular complications (HR 2.397; 95%CI 1.76-3.250; p<0.0001) and access-site cross over (HR 1.395; 95%CI 1.04-1.85; p=0.0233). Women have a higher risk of vascular complications compared to men and radial access is an effective method to prevent these complications.