Abstract
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). 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). 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.
Highlights
Advances in antithrombotic therapy in patients with acute coronary syndrome (ACS), along with an early invasive strategy in high-risk patients, have reduced the incidence of recurrent ischaemic events and increased bleeding complications.[1]
major adverse cardiovascular events (MACE) occurred in 121 (6.1%) segment elevation myocardial infarction (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
The RIVAL (A Trial of Trans-radial Versus Trans-femoral percutaneous coronary intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy) study reported inconsistent results in terms of the primary endpoint as well for mortality depending on presentation syndrome, namely non-ST-segment elevation ACS (NSTE-ACS) or STEMI.[4]
Summary
Advances in antithrombotic therapy in patients with acute coronary syndrome (ACS), along with an early invasive strategy in high-risk patients, have reduced the incidence of recurrent ischaemic events and increased bleeding complications.[1]. The Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial is the largest randomized trial to compare radial and femoral access in largely unselected patients with ACS with or without ST-segment elevation myocardial infarction (STEMI) undergoing coronary angiography and percutaneous coronary intervention (PCI). The RIVAL (A Trial of Trans-radial Versus Trans-femoral PCI Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy) study reported inconsistent results in terms of the primary endpoint as well for mortality depending on presentation syndrome, namely non-ST-segment elevation ACS (NSTE-ACS) or STEMI.[4] it remains unclear whether radial access should be preferred over femoral access across the entire spectrum of ACS patients
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