Effects of Radial Versus Femoral Artery Access in Patients With Acute Coronary Syndromes With or Without ST-Segment Elevation

被引：301

作者：

Mehta, Shamir R. ^{[1
,2
]}

Jolly, Sanjit S. ^{[1
,2
]}

Cairns, John ^{[3
]}

Niemela, Kari ^{[4
,5
]}

Rao, Sunil V. ^{[6
]}

Cheema, Asim N. ^{[7
]}

Steg, Philippe Gabriel ^{[8
,9
]}

Cantor, Warren J. ^{[10
]}

Dzavik, Vladimir ^{[11
]}

Budaj, Andrzej ^{[12
]}

Rokoss, Michael ^{[1
,2
]}

Valentin, Vicent ^{[13
]}

Gao, Peggy ^{[1
,2
]}

Yusuf, Salim ^{[1
,2
]}

机构：

[1] McMaster Univ, Hamilton, ON, Canada

[2] Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[3] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[4] Tampere Univ Hosp, Tampere, Finland

[5] Ctr Heart, Tampere, Finland

[6] Duke Univ, Duke Clin Res Inst, Durham, NC USA

[7] Univ Toronto, St Michaels Hosp, Toronto, ON M5B 1W8, Canada

[8] Univ Paris 07, INSERM, U698, Paris, France

[9] AP HP, Paris, France

[10] Southlake Reg Hlth Ctr, Newmarket, ON, Canada

[11] Univ Toronto, Univ Hlth Network, Toronto, ON, Canada

[12] Grochowski Hosp, Dept Cardiol, Postgrad Med Sch, Warsaw, Poland

[13] Hosp Univ Dr Peset, Valencia, Spain

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 60卷 / 24期

基金：

加拿大健康研究院;

关键词：

bleeding; percutaneous coronary intervention; radial artery; ST-segment elevation myocardial infarction; vascular access; ACUTE MYOCARDIAL-INFARCTION; RANDOMIZED-TRIALS; CLINICAL-TRIALS; PRIMARY ANGIOPLASTY; INTERVENTION; IMPACT; METAANALYSIS; ANGIOGRAPHY; STRATEGIES; REGISTRY;

D O I：

10.1016/j.jacc.2012.07.050

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The purpose of this study was to determine the consistency of the effects of radial artery access in patients with ST-segment elevation myocardial infarction (STEMI) and in those with non-ST-segment elevation acute coronary syndrome (NSTEACS). Background The safety associated with radial access may translate into mortality benefit in higher-risk patients, such as those with STEMI. Methods We compared efficacy and bleeding outcomes in patients randomized to radial versus femoral access in RIVAL (RadIal Vs femorAL access for coronary intervention trial) (N = 7,021) separately in those with STEMI (n = 1,958) and NSTEACS (n = 5,063). Interaction tests between access site and acute coronary syndrome type were performed. Results Baseline characteristics were well matched between radial and femoral groups. There were significant interactions for the primary outcome of death/myocardial infarction/stroke/non-coronary artery bypass graft-related major bleeding (p = 0.025), the secondary outcome of death/myocardial infarction/stroke (p = 0.011) and mortality (p = 0.001). In STEMI patients, radial access reduced the primary outcome compared with femoral access (3.1% vs. 5.2%; hazard ratio [HR]: 0.60; p = 0.026). For NSTEACS, the rates were 3.8% and 3.5%, respectively (p = 0.49). In STEMI patients, death/myocardial infarction/stroke were also reduced with radial access (2.7% vs. 4.6%; HR 0.59; p = 0.031), as was all-cause mortality (1.3% vs. 3.2%; HR: 0.39; p = 0.006), with no difference in NSTEACS patients. Operator radial experience was greater in STEMI versus NSTEACS patients (400 vs. 326 cases/year, p < 0.0001). In primary PCI, mortality was reduced with radial access (1.4% vs. 3.1%; HR: 0.46; p = 0.041). Conclusions In patients with STEMI, radial artery access reduced the primary outcome and mortality. No such benefit was observed in patients with NSTEACS. The radial approach may be preferred in STEMI patients when the operator has considerable radial experience. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273) (J Am Coll Cardiol 2012; 60:2490-9) (C) 2012 by the American College of Cardiology Foundation

引用

页码：2490 / 2499

页数：10

共 28 条

[1] Association of the arterial access site at angioplasty with transfusion and mortality: the MORTAL study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg) [J].

Chase, A. J. ;

Fretz, E. B. ;

Warburton, W. P. ;

Klinke, W. P. ;

Carere, R. G. ;

Pi, D. ;

Berry, B. ;

Hilton, J. D. .

HEART, 2008, 94 (08) :1019-1025

[2]

Defteres S, 2011, HELL J CARDIOL, V52, P111

[3] Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: A large single-center experience [J].

Eichhoefer, Jonas ;

Horlick, Eric ;

Ivanov, Joan ;

Seidelin, Peter H. ;

Ross, John R. ;

Ing, Douglas ;

Daly, Paul ;

Mackie, Karen ;

Ridley, Brenda ;

Schwartz, Leonard ;

Barolet, Alan ;

Dzavik, Vladimir .

AMERICAN HEART JOURNAL, 2008, 156 (05) :864-870

[4] Adverse impact of bleeding on prognosis in patients with acute coronary syndromes [J].

Eikelboom, John W. ;

Mehta, Shamir R. ;

Anand, Sonia S. ;

Xie, Changchun ;

Fox, Keith A. A. ;

Yusuf, Salim .

CIRCULATION, 2006, 114 (08) :774-782

[5] Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006 [J].

Fox, Keith A. A. ;

Steg, Philippe Gabriel ;

Eagle, Kim A. ;

Goodman, Shaun G. ;

Anderson, Frederick A., Jr. ;

Granger, Christopher B. ;

Flather, Marcus D. ;

Budaj, Andrzej ;

Quill, Ann ;

Gore, Joel M. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 297 (17) :1892-1900

[6] Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial [J].

Genereux, Philippe ;

Mehran, Roxana ;

Palmerini, Tullio ;

Caixeta, Adriano ;

Kirtane, Ajay J. ;

Lansky, Alexandra J. ;

Brodie, Bruce R. ;

Witzenbichler, Bernhard ;

Mockel, Martin ;

Guagliumi, Giulio ;

Peruga, Jan Z. ;

Dudek, Dariusz ;

Fahy, Martin P. ;

Dangas, George ;

Stone, Gregg W. .

EUROINTERVENTION, 2011, 7 (08) :905-916

[7] Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes [J].

Hamon, Martial ;

Mehta, Shamir ;

Steg, Ph Gabriel ;

Faxon, David ;

Kerkar, Prafulla ;

Rupprecht, Hans-Juergen ;

Tanguay, Jean-Francois ;

Afzal, Rizwan ;

Yusuf, Salim .

EUROINTERVENTION, 2011, 7 (01) :91-97

[8] Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial [J].

Jolly, Sanjit S. ;

Yusuf, Salim ;

Cairns, John ;

Niemela, Kari ;

Xavier, Denis ;

Widimsky, Petr ;

Budaj, Andrzej ;

Niemela, Matti ;

Valentin, Vicent ;

Lewis, Basil S. ;

Avezum, Alvaro ;

Steg, Philippe Gabriel ;

Rao, Sunil V. ;

Gao, Peggy ;

Afzal, Rizwan ;

Joyner, Campbell D. ;

Chrolavicius, Susan ;

Mehta, Shamir R. .

LANCET, 2011, 377 (9775) :1409-1420

[9] Design and rationale of the RadIal Vs. femorAL access for coronary intervention (RIVAL) trial: A randomized comparison of radial versus femoral access for coronary angiography or intervention in patients with acute coronary syndromes [J].

Jolly, Sanjit S. ;

Niemela, Kari ;

Xavier, Denis ;

Widimsky, Petr ;

Budaj, Andrzej ;

Valentin, Vicent ;

Lewis, Basil S. ;

Avezum, Alvaro ;

Steg, Philippe Gabriel ;

Rao, Sunil V. ;

Cairns, John ;

Chrolavicius, Susan ;

Yusuf, Salim ;

Mehta, Shamir R. .

AMERICAN HEART JOURNAL, 2011, 161 (02) :254-+

[10] Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials [J].

Jolly, Sanjit S. ;

Amlani, Shoaib ;

Hamon, Martial ;

Yusuf, Salim ;

Mehta, Shamir R. .

AMERICAN HEART JOURNAL, 2009, 157 (01) :132-140

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