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http://hdl.handle.net/1942/33268
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DC Field | Value | Language |
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dc.contributor.author | Gargiulo, Giuseppe | - |
dc.contributor.author | Valgimigli, Marco | - |
dc.contributor.author | Sunnaker, Mikael | - |
dc.contributor.author | VRANCKX, Pascal | - |
dc.contributor.author | Frigoli, Enrico | - |
dc.contributor.author | Leonardi, Sergio | - |
dc.contributor.author | Spirito, Alessandro | - |
dc.contributor.author | Gragnano, Felice | - |
dc.contributor.author | Manavifar, Negar | - |
dc.contributor.author | Galea, Roberto | - |
dc.contributor.author | De Caterina, Alberto R. | - |
dc.contributor.author | Calabro, Paolo | - |
dc.contributor.author | Esposito, Giovanni | - |
dc.contributor.author | Windecker, Stephan | - |
dc.contributor.author | Hunziker, Lukas | - |
dc.date.accessioned | 2021-02-02T13:24:25Z | - |
dc.date.available | 2021-02-02T13:24:25Z | - |
dc.date.issued | 2020 | - |
dc.date.submitted | 2021-01-13T12:23:38Z | - |
dc.identifier.citation | REVISTA ESPANOLA DE CARDIOLOGIA, 73 (11) , p. 893 -901 | - |
dc.identifier.uri | http://hdl.handle.net/1942/33268 | - |
dc.description.abstract | Introduction and objectives: Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited. We assessed outcomes of transradial vs transfemoral access and bivalirudin vs unfractionated heparin (UFH) in VP with acute coronary syndrome undergoing invasive management.Methods: The MATRIX trial randomized 8404 patients to radial or femoral access and 7213 patients to bivalirudin or UFH. Among them, 934 (11.1%) were deemed VP due to advanced Killip class (n = 808), cardiac arrest (n = 168), or both (n = 42). The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACE: death, myocardial infarction, or stroke) and net adverse clinical events (NACE: MACE or major bleeding).Results: MACE and NACE were similarly reduced with radial vs femoral access in VP and non-VP. Transradial access was also associated with consistent relative benefits in all-cause and cardiovascular mortality or Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding with greater absolute benefits in VP. The effects of bivalirudin vs UFH on MACE and NACE were consistent in VP and non-VP. Bivalirudin was associated with lower all-cause and cardiovascular mortality in VP but not in non-VP, with borderline interaction testing. Bivalirudin reduced bleeding in both VP and non-VP with a larger absolute benefit in VP.Conclusions: In acute coronary syndrome patients undergoing invasive management, the effects of randomized treatments were consistent in VP and non-VP, but absolute risk reduction with radial access and bivalirudin were greater in VP, with a 5- to 10-fold lower number needed to treat for benefits. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved. | - |
dc.language.iso | en | - |
dc.publisher | EDICIONES DOYMA S A | - |
dc.subject.other | Acute coronary syndrome | - |
dc.subject.other | Radial access | - |
dc.subject.other | Bivalirudin | - |
dc.subject.other | Vulnerable patients | - |
dc.subject.other | Acute heart failure | - |
dc.subject.other | Cardiac arrest | - |
dc.title | Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest | - |
dc.title.alternative | Lugar de acceso y tipo de anticoagulante en pacientes con sÃndrome coronario agudo en clase Killip avanzada o con parada cardiaca extrahospitalaria | - |
dc.type | Journal Contribution | - |
dc.identifier.epage | 901 | - |
dc.identifier.issue | 11 | - |
dc.identifier.spage | 893 | - |
dc.identifier.volume | 73 | - |
local.format.pages | 9 | - |
local.bibliographicCitation.jcat | A1 | - |
dc.description.notes | Valgimigli, M (corresponding author), Bern Univ Hosp, Dept Cardiol, CH-3010 Berna, Switzerland. | - |
dc.description.notes | marco.valgimigli@insel.ch | - |
dc.description.other | Valgimigli, M (corresponding author), Bern Univ Hosp, Dept Cardiol, CH-3010 Berna, Switzerland. marco.valgimigli@insel.ch | - |
local.publisher.place | TRAV DE GRACIA 17-21, 08021 BARCELONA, SPAIN | - |
local.type.refereed | Refereed | - |
local.type.specified | Article | - |
dc.identifier.doi | 10.1016/j.recesp.2020.01.012 | - |
dc.identifier.isi | WOS:000585706300007 | - |
dc.contributor.orcid | Spirito, Alessandro/0000-0002-7473-6577 | - |
local.provider.type | wosris | - |
local.uhasselt.uhpub | yes | - |
local.description.affiliation | [Gargiulo, Giuseppe; Valgimigli, Marco; Frigoli, Enrico; Spirito, Alessandro; Gragnano, Felice; Manavifar, Negar; Galea, Roberto; Windecker, Stephan; Hunziker, Lukas] Bern Univ Hosp, Dept Cardiol, CH-3010 Berna, Switzerland. | - |
local.description.affiliation | [Gargiulo, Giuseppe; Esposito, Giovanni] Federico II Univ Naples, Dept Adv Biomed Sci, Naples, Italy. | - |
local.description.affiliation | [Sunnaker, Mikael] Univ Bern, Clin Trials Unit CTU Bern, Berna, Switzerland. | - |
local.description.affiliation | [Vranckx, Pascal] Jessa Ziekenhuis, Dept Cardiol & Crit Care Med, Hartctr Hasselt, Hasselt, Belgium. | - |
local.description.affiliation | [Vranckx, Pascal] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. | - |
local.description.affiliation | [Leonardi, Sergio] Fdn IRCCS Policlin San Matteo, Pavia, Italy. | - |
local.description.affiliation | [Gragnano, Felice; Calabro, Paolo] Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, Div Cardiol, Naples, Italy. | - |
local.description.affiliation | [De Caterina, Alberto R.] Osped Cuore Massa, Fdn Toscana G Monasterio, Pisa, Italy. | - |
local.uhasselt.international | yes | - |
item.fullcitation | Gargiulo, Giuseppe; Valgimigli, Marco; Sunnaker, Mikael; VRANCKX, Pascal; Frigoli, Enrico; Leonardi, Sergio; Spirito, Alessandro; Gragnano, Felice; Manavifar, Negar; Galea, Roberto; De Caterina, Alberto R.; Calabro, Paolo; Esposito, Giovanni; Windecker, Stephan & Hunziker, Lukas (2020) Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest. In: REVISTA ESPANOLA DE CARDIOLOGIA, 73 (11) , p. 893 -901. | - |
item.accessRights | Open Access | - |
item.fulltext | With Fulltext | - |
item.validation | ecoom 2021 | - |
item.contributor | Gargiulo, Giuseppe | - |
item.contributor | Valgimigli, Marco | - |
item.contributor | Sunnaker, Mikael | - |
item.contributor | VRANCKX, Pascal | - |
item.contributor | Frigoli, Enrico | - |
item.contributor | Leonardi, Sergio | - |
item.contributor | Spirito, Alessandro | - |
item.contributor | Gragnano, Felice | - |
item.contributor | Manavifar, Negar | - |
item.contributor | Galea, Roberto | - |
item.contributor | De Caterina, Alberto R. | - |
item.contributor | Calabro, Paolo | - |
item.contributor | Esposito, Giovanni | - |
item.contributor | Windecker, Stephan | - |
item.contributor | Hunziker, Lukas | - |
crisitem.journal.issn | 0300-8932 | - |
crisitem.journal.eissn | 1579-2242 | - |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
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author version.pdf | Peer-reviewed author version | 1.01 MB | Adobe PDF | View/Open |
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