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Title: Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasivemanagement: secondary analysis of a randomized clinical trial
Authors: Rothenbuehler, Martina
Valgimigli, Marco
Odutayo, Ayodele
Frigoli, Enrico
Leonardi, Sergio
Vranckx, Pascal 
Turturo, Maurizio
Moretti, Luciano
Amico, Francesco
Uguccioni, Lucia
Contarini, Marco
Antoni Gomez-Hospital, Joan
Mainar, Vicente
Creaco, Manuela
Petronio, Anna Sonia
Cremonesi, Alberto
Tamburino, Corrado
Fresco, Claudio
Bonmassari, Roberto
Diaz Fernandez, Jose Francisco
Romagnoli, Enrico
Beyersmann, Jan
Heg, Dik
Juni, Peter
Issue Date: 2019
Source: EUROPEAN HEART JOURNAL, 40(15), p. 1226-1232a
Abstract: Aims In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial, adults with acute coronary syndrome undergoing coronary intervention who were allocated to radial access had a lower risk of bleeding, acute kidney injury (AKI), and all-cause mortality, as compared with those allocated to femoral access. The mechanism of the mortality benefit of radial access remained unclear. Methods and results We used multistate and competing risk models to determine the effects of radial and femoral access on bleeding, AKI and all-cause mortality in the MATRIX trial and to disentangle the relationship between these different types of events. There were large relative risk reductions in mortality for radial compared with femoral access for the transition from AKI to death [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.31-0.97] and for the pathway from coronary intervention to AKI to death (HR 0.49, 95% CI 0.26-0.92). Conversely, there was little evidence for a difference between radial and femoral groups for the transition from bleeding to death (HR 1.05, 95% CI 0.42-2.64) and the pathway from coronary intervention to bleeding to death (HR 0.84, 95% CI 0.28-2.49). Conclusion The prevention of AKI appeared predominantly responsible for the mortality benefit of radial as compared with femoral access in the MATRIX trial. There was little evidence for an equally important, independent role of bleeding.
Notes: [Rothenbuehler, Martina; Frigoli, Enrico; Heg, Dik] Univ Bern, CTU Bern, Mittelstr 43, CH-3012 Bern, Switzerland. [Rothenbuehler, Martina; Frigoli, Enrico; Heg, Dik] Univ Bern, ISPM, Mittelstr 43, CH-3012 Bern, Switzerland. [Valgimigli, Marco] Bern Univ Hosp, Swiss Cardiovasc Ctr Bern, Freiburgstr 8, CH-3010 Bern, Switzerland. [Odutayo, Ayodele; Juni, Peter] Univ Toronto, Dept Med, St Michaels Hosp, Appl Hlth Res Ctr,Li Ka Shing Knowledge Inst, 30 Bond St, Toronto, ON M5B 1W8, Canada. [Odutayo, Ayodele; Juni, Peter] Univ Toronto, Inst Hlth Policy Management & Evaluat, 30 Bond St, Toronto, ON M5B 1W8, Canada. [Leonardi, Sergio] Fdn IRCCS Policlin San Matteo, Coronary Care Unit, Viale Golgi 19, I-27100 Pavia, Italy. [Vranckx, Pascal] Jessa Ziekenhuis, Hartctr Hasselt, Dept Cardiol & Crit Care Med, Stadsomvaart 11, B-3500 Hasselt, Belgium. [Vranckx, Pascal] Univ Hasselt, Fac Med & Life Sci, Martelarenlaan 42, B-3500 Hasselt, Belgium. [Turturo, Maurizio] Div Cardiol, PO Di Venere,Via Osped Venere 1, I-70131 Bari, Italy. [Moretti, Luciano] Mazzoni Hosp, Div Cardiol, Via Iris, I-63100 Ascoli Piceno, Italy. [Amico, Francesco] S Elia Hosp, Cardiol Unit, Via Luigi Russo 6, I-93100 Caltanissetta, Italy. [Uguccioni, Lucia] Osped Riuniti Marche Nord, Intervent Cardiol, Piazzale Cinelli 4, I-61121 Pesaro, Italy. [Contarini, Marco] Umberto I Hosp, Intervent Cardiol Unit, Via Testaferrata 1, I-96100 Siracusa, Italy. [Antoni Gomez-Hospital, Joan] Bellvitge Univ Hosp, Heart Dis Inst, Feixa Uarga S-N, Barcelona 08907, Spain. [Mainar, Vicente] Hosp Gen Alicante, Dept Cardiol, Pintor Baeza 11, Alicante 03010, Spain. [Creaco, Manuela] Gravina Hosp, Cardiol Unit, Via Portosalvo 9, I-95041 Caltagirone, Italy. [Petronio, Anna Sonia] Univ Pisa, Osped Cisanello, Cardiothorac & Vasc Dept, Unit Intervent Cardiol, Via Paradisa 2, I-56124 Pisa, Italy. [Cremonesi, Alberto] Humanitas Gavazzeni Hosp, Cardiovasc Dept, Via M Gavazzeni 21, I-24125 Bergamo, Italy. [Tamburino, Corrado] CAST Policlin Univ Hosp, Cardiothorax Vasc & Transplant Dept, Cardiol Div, Via S Sofia 76, I-95123 Catania, Italy. [Fresco, Claudio] Azienda Sanit Univ Integrata Udine, Cardiol Unit, Piazzale S Maria della Misericordia 15, I-33100 Udine, Italy. [Bonmassari, Roberto] Santa Chiara Hosp, Div Cardiol, Largo Medaglie Doro 9, I-38122 Trento, Italy. [Diaz Fernandez, Jose Francisco] Juan Ramon Jimenez Univ Hosp, Intervent Cardiol Dept, Ronda Norte Sn, Huelva 21005, Spain. [Romagnoli, Enrico] Fdn Policlin Univ A Gemelli, Dept Cardiol, Largo Agostino Gemelli 8, I-00168 Rome, Italy. [Beyersmann, Jan] Ulm Univ, Inst Stat, Helmholtzstr 20, D-89081 Ulm, Germany.
Keywords: Acute coronary syndrome; Percutaneous coronary intervention; Multistate model; Competing risk model;Acute coronary syndrome; Percutaneous coronary intervention; Multistate model; Competing risk model
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ISSN: 0195-668X
e-ISSN: 1522-9645
DOI: 10.1093/eurheartj/ehy860
ISI #: 000490013100017
Rights: The Author(s) 2019
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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