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Title: | Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management Data From the Randomized MATRIX-Access Trial | Authors: | Gargiulo, Giuseppe Ariotti, Sara VRANCKX, Pascal Leonardi, Sergio Frigoli, Enrico Ciociano, Nestor Tumscitz, Carlo Tomassini, Francesco Calabro, Paolo Garducci, Stefano Crimi, Gabriele Ando, Giuseppe Ferrario, Maurizio Limbruno, Ugo Cortese, Bernardo Sganzerla, Paolo Lupi, Alessandro Russo, Filippo Garbo, Roberto Ausiello, Arturo Zavalloni, Dennis Sardella, Gennaro Esposito, Giovanni Santarelli, Andrea Tresoldi, Simone Nazzaro, Marco Stefano Zingarelli, Antonio Petronio, Anna Sonia Windecker, Stephan da Costa, Bruno R. Valgimigli, Marco |
Issue Date: | 2018 | Publisher: | ELSEVIER SCIENCE INC | Source: | JACC-CARDIOVASCULAR INTERVENTIONS, 11(1), p. 36-50 | Abstract: | OBJECTIVES This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management. BACKGROUND There are limited and contrasting data about sex disparities for the safety and efficacy of TRA versus TFA for coronary intervention. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) program, 8,404 patients were randomized to TRA or TFA. The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACCE or major bleeding. RESULTS Among 8,404 patients, 2,232 (26.6%) were women and 6,172 (73.4%) were men. MACCE and NACE were not significantly different between men and women after adjustment, but women had higher risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p = 0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR: 0.56; p = 0.0089). When comparing radial versus femoral, there was no significant interaction for MACCE and NACE stratified by sex (p(int) = 0.15 and 0.18, respectively), although for both coprimary endpoints the benefit with TRA was relatively greater in women (RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly, there was no significant interaction between male and female patients for the individual endpoints of all-cause death (p(int) = 0.79), myocardial infarction (p(int) = 0.25), stroke (p(int) = 0.18), and Bleeding Academic Research Consortium type 3 or 5 (p(int) = 0.45). CONCLUSIONS Women showed a higher risk of severe bleeding and access site complications, and radial access was an effective method to reduce these complications as well as composite ischemic and ischemic or bleeding endpoints. (C) 2018 by the American College of Cardiology Foundation. | Notes: | [Gargiulo, Giuseppe; Ariotti, Sara; Frigoli, Enrico; Windecker, Stephan; da Costa, Bruno R.; Valgimigli, Marco] Bern Univ Hosp, Dept Cardiol, Bern, Switzerland. [Gargiulo, Giuseppe; Esposito, Giovanni] Federico II Univ Naples, Dept Adv Biomed Sci, Naples, Italy. [Vranckx, Pascal] Jessa Ziekenhuis, Hartcentrum Hasselt, Dept Cardiol & Crit Care Med, Hasselt, Belgium. [Vranckx, Pascal] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. [Leonardi, Sergio; Crimi, Gabriele; Ferrario, Maurizio] Fdn IRCCS, Policlin San Matteo, Dipartimento CardioToracoVasc, UOC Cardiol, Pavia, Italy. [Ciociano, Nestor] EUSTRATEGY Assoc, Forli, Italy. [Tumscitz, Carlo] Azienda Osped Univ Ferrara, Cardiol Unit, Cona, Italy. [Tomassini, Francesco] ASL Torino 3, Ospedali Riuniti Rivoli, Cardiol Unit, Turin, Italy. [Calabro, Paolo] Univ Campania Luigi Vanvitelli, Dept Cardiothorac Sci, Div Cardiol, Naples, Italy. [Garducci, Stefano] Struttura Complessa Cardiol ASST Vimercate, Desio, Italy. [Crimi, Gabriele] ASL3 Osped Villa Scassi, Dept Cardiol, Genoa, Italy. [Ando, Giuseppe] Univ Messina, Azienda Osped Univ Policlin Martino, Messina, Italy. [Limbruno, Ugo] Azienda USL Toscana Sudest, UO Cardiol, Grosseto, Italy. [Cortese, Bernardo] ASST Fatebenefratelli Sacco, Milan, Italy. [Cortese, Bernardo] Fdn Toscana Gabriele Monasterio, Pisa, Italy. [Sganzerla, Paolo] Osped Treviglio, ASST Bergamo Ovest, Bergamo, Italy. [Lupi, Alessandro] Univ Hosp Maggiore Carita, Cardiol Unit, Novara, Italy. [Russo, Filippo] St Anna Hosp, Cardiol Dept, Cardiovasc Intervent Unit, Como, Italy. [Garbo, Roberto] Osped San Giovanni Bosco, Intervent Cardiol Unit, Turin, Italy. [Ausiello, Arturo] Casa Cura Villa Verde, Taranto, Italy. [Zavalloni, Dennis] IRCCS, Humanitas Res Hosp, Rozzano, Italy. [Sardella, Gennaro] Sapienza Univ Rome, Policlin Umberto 1, Dept Cardiovasc, Resp,Nephrol Anesthesiol & Geriatr Sci, Rome, Italy. [Santarelli, Andrea] Infermi Hosp, Cardiovasc Dept, Rimini, Italy. [Tresoldi, Simone] AO Osped Desio, Cardiol Unit, Desio, Italy. [Nazzaro, Marco Stefano] San Camillo Forlanini, Intervent Cardiol Unit, Rome, Italy. [Zingarelli, Antonio] IRCCS AOU San Martino, Intervent Cardiol Unit, Genoa, Italy. [Petronio, Anna Sonia] Univ Pisa, Cardiothorac & Vasc Dept, Catheterisat Lab, Pisa, Italy. [da Costa, Bruno R.] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland. | Keywords: | acute coronary syndrome(s); female; femoral access; male; MATRIX; radial access;acute coronary syndrome(s); female; femoral access; male; MATRIX; radial access | Document URI: | http://hdl.handle.net/1942/26577 | ISSN: | 1936-8798 | e-ISSN: | 1876-7605 | DOI: | 10.1016/j.jcin.2017.09.014 | ISI #: | 000419122800009 | Rights: | (C) 2018 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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