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Title: | Radial vs Femoral Access in ACS Patients Undergoing Complex PCI Is Associated With Consistent Bleeding Benefit and No Excess of Risks | Authors: | Landi, Antonio Branca, Mattia VRANCKX, Pascal Leonardi, Sergio Frigoli, Enrico Heg, Dik Calabro, Paolo Esposito, Giovanni Sardella, Gennaro Tumscitz, Carlo Garducci, Stefano Ando, Giuseppe Limbruno, Ugo Sganzerla, Paolo Santarelli, Andrea Briguori, Carlo De la Torre Hernandez, Jose M. Pedrazzini, Giovanni Windecker, Stephan Valgimigli, Marco |
Issue Date: | 2022 | Publisher: | ELSEVIER SCIENCE INC | Source: | CANADIAN JOURNAL OF CARDIOLOGY, 38 (10) , p. 1488 -1500 | Abstract: | Background: The comparative effectiveness of transradial (TRA) compared with transfemoral (TFA) access in acute coronary syndrome (ACS) patients undergoing complex percutaneous coronary intervention (PCI) remains unclear. Methods: Among 8404 ACS patients in the Minimising Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX (MATRIX)dAccess trial, 5233 underwent noncomplex (TRA: n = 2590; TFA: n = 2643) and 1491 complex (TRA: n = 777; TFA: n = 714) PCI. Co-primary outcomes were major adverse cardiovascular events (MACE, the composite of all-cause mortality, myocardial infarction, or stroke) and the composite of MACE and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (net adverse cardiovascular events [NACE]) at 30 days. Results: Rates of 30-day MACE (HR 0.94, 95% CI 0.72-1.22) or NACE (HR 0.89, 95% CI 0.69-1.14) did not significantly differ between groups in the complex PCI group, whereas both primary end points were lower (HR 0.84, 95% CI 0.70-1.00; HR 0.83, 95% CI 0.70-0.98; respectively) with TRA among noncomplex PCI patients, with negative interaction testing (Pint = 0.473 and 0.666, respectively). Access-site BARC type 3 or 5 bleeding was lower with TRA, consistently among complex (HR 0.18, 95% CI 0.05-0.63) and noncomplex (HR 0.41, 95% CI 0.20-0.85) PCI patients, whereas the former group had a greater absolute risk reduction of 1.7% (number needed to treat: 59) owing to their higher absolute risk. Conclusions: Among ACS patients, PCI complexity did not affect the comparative efficacy and safety of TRA vs TFA, whereas the absolute risk reduction of access-site major bleeding was greater with TRA compared with TFA in complex as opposed to noncomplex PCI. | Notes: | Valgimigli, M (corresponding author), Ente Ospedal Cantonale, Cardioctr Ticino Inst, Via Tesserete 48, CH-6900 Lugano, Switzerland. marco.valgimigli@eoc.ch |
Keywords: | Femoral Artery;Hemorrhage;Humans;Radial Artery;Risk Factors;Treatment Outcome;Acute Coronary Syndrome;Percutaneous Coronary Intervention | Document URI: | http://hdl.handle.net/1942/40816 | ISSN: | 0828-282X | e-ISSN: | 1916-7075 | DOI: | 10.1016/j.cjca.2022.06.014 | ISI #: | 001043774400001 | Rights: | 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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