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MACE
Meta-analyses of all comers to angiography =
ACS patients planned for an invasive strategy
Between '06 and '10 7021 patients were enrolled from 158 hospitals in 32 countries
0.9%
7.0%
But what about high risk patients?
Mortality
SCAAR registry (7):
Primary outcome = Death, MI, stroke, or Non-CABG related major bleeding within 30 days
Secondary outcomes: Major access site complications and PCI success
99.8% Angiogram
66.4% PCI
8.5% CABGs
Radial approach significantly reduces access site related major bleeding (4):
Major bleeding is an independent predictor of mortality (5)
Access site bleeding accounts for around 50% of bleeding on long term follow up (6)
707 STEMI patients
1:1 randomisation to radial or femoral
Same medical therapy
Radiation exposure is related to operator experience and access route (2).
Primary outcome (Death, MI, stroke, major bleeding at 30 days):
No significant difference in primary endpoints or components including Major Bleeding
Secondary endpoints:
Pre-specified subgroup analysis, Primary outcome:
References
1. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary Palmaz-Schatz stent implantation. Am Heart J. 1994;128:167-74.
2. Jolly SS, Yusuf S, Cairns J et al; RIVAL trial group. Radial versus femoral access for coronary angi- ography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409-20.
3.Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial Versus Femoral Randomized Investigation in ST-Segment Elevation Acute Coronary Syndrome: The RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) Study. J Am Coll Cardiol. 2012;60:2481-9.
4. Hamon M, Pristipino C, Di Mario C, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and working groups on acute cardiac care and thrombosis of the European Society of Cardiology. EuroIntervention 2013
5. Cayla G,Silvain J,Barthelemy O et al; ABOARD investigators. Trans-radial approach for catheterisation in non-ST segment elevation acute coronary syn- drome: an analysis of major bleeding complications in the ABOARD Study. Heart. 2011;97:887-91.
6. Verheugt FW, Steinhubl SR, Hamon M et al. Incidence, prognostic impact, and influence of antithrombotic therapy on access and nonaccess site bleeding in percutaneous coronary intervention. JACC Cardiovasc Interv. 2011;4:191-7.
7. Olivecrona GK, Lagerqvist B, Gotberg M et al. Lower Mortality with Transradial PCI Compared to Transfemoral PCI in 21,000 Patients with Acute Myocardial Infarction- Results from the SCAAR Database. EuroPCR 2011
8.Bernat I. STEMI-RADIAL: A prospective, randomized trial of radial vs. femoral access in patients with ST-Segment elevation myocardial infarction. TCT 2012; October 26, 2012; Miami, FL
SUMMARY
Bleeding
RIVAL major bleeding =
Fatal, ≥ 2 units PRBCs, causing hypotension needing vasopressors, caused severe disabling sequelae, intracranial and symptomatic, or drop in Hb ≥ 50g/L
ACUITY major Bleeding
Does the Radial Artery belong to the Interventionalist or the Surgeon?
Compared with Femoral access Radial angiography has been shown to:
More recently the radial approach has been shown to:
1948 Radner cutdown
1989 Campeau Percutaneous
1992 Kiemeneij PCI
Austin Health, Victoria, Australia