Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/34172
Title: | Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management | Authors: | Gragnano, Felice Branca, Mattia Frigoli, Enrico Leonardi, Sergio VRANCKX, Pascal Di Maio, Dario Monda, Emanuele Fimiani, Luigi Fioretti, Vincenzo Chianese, Salvatore Esposito, Fabrizio Franzese, Michele Scalise, Martina D'Angelo, Claudio Scalise, Renato De Blasi, Gabriele Ando, Giuseppe Esposito, Giovanni Calabro, Paolo Windecker, Stephan Pedrazzini, Giovanni Valgimigli, Marco |
Issue Date: | 2021 | Publisher: | ELSEVIER SCIENCE INC | Source: | JACC-Cardiovascular Interventions, 14 (4) , p. 361 -373 | Abstract: | OBJECTIVES The aim of this study was to assess the impact of access-site crossover in patients with acute coronary syndrome undergoing invasive management via radial or femoral access. BACKGROUND There are limited data on the clinical implications of access-site crossover. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox)-Access trial, 8,404 patients with acute coronary syndrome were randomized to radial or femoral access. Patients undergoing access-site crossover or successful access site were investigated. Thirty-day coprimary outcomes were a composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and a composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding (net adverse clinical events [NACE]). RESULTS Access-site crossover occurred in 183 of 4,197 patients (4.4%) in the radial group (mainly to femoral access) and 108 of 4,207 patients (2.6%) in the femoral group (mainly to radial access). In multivariate analysis, the risk for coprimary outcomes was not significantly higher with radial crossover compared with successful radial (MACE: adjusted rate ratio [adjRR]: 1.25; 95% confidence interval [CI]: 0.81 to 1.93; p = 0.32; NACE: adjRR: 1.40; 95% CI: 0.94 to 2.06; p = 0.094) or successful femoral access (MACE: adjRR: 1.17; 95% CI: 0.76 to 1.81; p = 0.47; NACE: adjRR: 1.26; 95% CI: 0.86 to 1.86; p = 0.24). Access site-related Bleeding Academic Research Consortium type 3 or 5 bleeding was higher with radial crossover than successful radial access. Femoral crossover remained associated with higher risks for MACE (adjRR: 1.84; 95% CI: 1.18 to 2.87; p = 0.007) and NACE (adjRR: 1.69; 95% CI: 1.09 to 2.62; p = 0.019) compared with successful femoral access. Results remained consistent after excluding patients with randomized access not attempted. CONCLUSIONS Crossover from radial to femoral access abolishes the bleeding benefit offered by the radial over femoral artery but does not appear to increase the risk for MACE or NACE compared with successful radial or femoral access. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627) (C) 2021 by the American College of Cardiology Foundation. | Notes: | Valgimigli, M (corresponding author), Ente Osped Cantonale, Cardioctr Ticino Inst, Via Tesserete 48, CH-6900 Lugano, Switzerland. marco.valgimigli@cardiocentro.org |
Other: | Valgimigli, M (corresponding author), Ente Osped Cantonale, Cardioctr Ticino Inst, Via Tesserete 48, CH-6900 Lugano, Switzerland. marco.valgimigli@cardiocentro.org | Keywords: | acute coronary syndrome;crossover;femoral access;percutaneous coronary intervention;radial access | Document URI: | http://hdl.handle.net/1942/34172 | ISSN: | 1936-8798 | e-ISSN: | 1876-7605 | DOI: | 10.1016/j.jcin.2020.11.042 | ISI #: | WOS:000632036700004 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
1-s2.0-S1936879820323773-main.pdf | Published version | 906.21 kB | Adobe PDF | View/Open |
WEB OF SCIENCETM
Citations
25
checked on Jun 9, 2024
Page view(s)
24
checked on May 20, 2022
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.