Radial to femoral access crossover during invasive management of acute coronary syndrome was associated with higher risk for bleeding than successful radial access, according to a study published in the Journal of the American College of Cardiologists: Cardiovascular Interventions.

This analysis was a prespecified substudy of the Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox randomized, multicenter, superiority trial of radial and femoral catheterization access for invasive management of acute coronary syndrome (ClinicalTrials.gov Identifier: NCT01433627). Patients (N=8404) were randomly assigned to receive femoral or radial access and were assessed for major adverse cardiovascular events (MACE), Bleeding Academic Research Consortium (BARC) events, and net adverse events through 30 days.

In patients undergoing radial access, 4.4% required crossover to femoral (n=178) or brachial (n=5) access, and among patients undergoing femoral access, 2.6% required crossover to radial (n=107) or brachial (n=1) access.


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Patients who had radial crossover were on average 5 years older and more likely to be women compared with other groups. Both crossover groups included a greater percentage of patients with diabetes and were given a higher volume of contrast fluid.

At 30 days, patients undergoing radial crossover were not found to have an increased risk for MACE (adjusted rate ratio [aRR], 1.25; 95% CI, 0.81-1.93; P =.32) or net adverse events (aRR, 1.40; 95% CI, 0.94-2.06; P =.090) compared with those who had successful radial access. Risk for BARC events 3 or 5 were elevated in the radial access crossover group (aRR, 9.65; 95% CI, 2.49-37.41; P =.001) as were need for surgical access repair or transfusion (aRR, 2.60; 95% CI, 1.01-6.67; P =.047).

At follow-up the patients who underwent femoral access crossover had an increased risk for MACE (aRR, 1.84; 95% CI, 1.18-2.87; P =.007) and net adverse events (aRR, 1.69; 95% CI, 1.09-2.62; P =.019) compared with those who had successful femoral access. Risk for BARC 3 or 5 events was not elevated among patients who underwent femoral crossover (aRR, 1.27; 95% CI, 0.37-4.35; P =.69).

Risk for a composite of death, myocardial infarction, or stroke was increased among patients requiring femoral crossover compared with those with successful femoral procedures (aRR, 1.78; 95% CI, 1.01-3.16; P =.049), and risk for a composite of death, myocardial infarction, stroke, or BARC 3 or 5 events was elevated among patients requiring radial crossover compared with those with successful radial access (aRR, 1.53; 95% CI, 1.02-2.30; P =.037).

Study limitations include the fact that access-site management was not uniform across local practices.

“Our results lend further support to use of the radial artery as the default approach in patients with ACS,” concluded the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Gragnano F, Branca M, Frigoli E, et al. Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management. JACC Cardiovasc Interv. 2021;14(4):361-373. doi:10.1016/j.jcin.2020.11.042