Radial Access Reduced Adverse Events in Intervention for Acute Coronary Syndrome

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Myocardial infarction, stent thrombosis, and stroke did not differ significantly between the radial access and femoral access groups.
Myocardial infarction, stent thrombosis, and stroke did not differ significantly between the radial access and femoral access groups.

Patients undergoing invasive therapies for acute coronary syndrome (ACS) with a radial access site had fewer net adverse clinical events at 1 year than those with a femoral access site, according to the results of a study presented at the European Society of Cardiology Congress in Munich, Germany, that were simultaneously published in the Lancet.

Major adverse cardiovascular events and net adverse clinical events were recorded from patients with ACS undergoing coronary angiography in the MATRIX trial (ClinicalTrials.gov Identifier: NCT01433627), a randomized, multicenter, open-label, superiority trial. Participants were randomly assigned 1:1 to receive either a radial or femoral access site and compared between groups. Another analysis of the study compared the effects of bivalirudin and unfractionated heparin. Patient follow-up continued 1 year after the procedure.

Among the 8404 patients enrolled in the study, 4197 were randomly assigned to radial access, whereas 4207 patients were assigned to femoral access. At 1 year, follow-up information was available for 99.8% of participants. Major adverse cardiovascular events occurred in 14.2% of patients in the radial access group and 15.7% of patients in the femoral access group (P= .0526). However, the other coprimary outcome finding was significant. Net adverse cardiac events occurred in 15.2% of patients with radial access and 17.2% with femoral access (P =.0128). Myocardial infarction, stent thrombosis, and stroke did not differ significantly between groups.

In the secondary analysis of the trial, no statistically significant differences were seen in major cardiac adverse events (P =. 28) and net adverse clinical events (P =.10) between the bivalirudin and heparin groups.

The researchers wrote, “Among patients with acute coronary syndrome undergoing invasive management, with or without ST-segment elevation, we found that use of radial access for coronary angiography, followed by percutaneous coronary intervention if indicated, was associated with reduced net adverse clinical events at 1 year.” 

They added, “[O]ur study offers novel long-term data in the largest population investigated so far, suggesting that the benefits of radial access are not affected by parenteral or oral antithrombotic medications used during or after coronary intervention.”

Reference

Valgimigli M, Frigoli E, Leonardi S, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial [published online August 25, 2018]. Lancet. doi:10.1016/S0140-6736(18)31714-8

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