Document Detail


Transradial versus transfemoral percutaneous coronary intervention in acute coronary syndromes: re-evaluation of the current body of evidence.
MedLine Citation:
PMID:  24262614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recent literature has argued the superiority of radial access compared with femoral access for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Three particular trials-RIVAL (Radial Versus Femoral Access for Coronary Intervention), RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome), and STEMI-RADIAL (ST Elevation Myocardial Infarction Treated by Radial or Femoral Approach-Randomized Multicenter Study Comparing Radial Versus Femoral Approach in Primary PCI)-demonstrated lower rates of bleeding and vascular complications with the transradial approach. Bleeding is a major independent predictor of negative long-term outcomes including death, predisposes patients to transfusions, and attenuates the ability to administer cardioprotective post-procedural anticoagulation. These trials, however, employed suboptimal antithrombotic practices. Namely, the dose of heparin and percent of patients on glycoprotein IIb/IIIa inhibitors were unnecessarily high, and a paucity of patients were on bivalirudin, which decreases bleeding and improves outcomes compared with heparin and glycoprotein IIb/IIIa inhibitors. The use of larger gauge catheters in femoral access patients predisposed them to major bleeding and its subsequent complications. In addition, these trials were carried forth in high-volume transradial centers, further limiting the ability to generalize the findings to most PCI centers. These are important considerations especially for high-risk and ACS patients, in whom the negative implications of major bleeding are even greater. Without an optimized design, the applications of the trial findings are uncertain. Ultimately, a trial comparing femoral versus radial access in patients on bivalirudin, potent oral antiplatelet medication, and without adjunctive glycoprotein IIb/IIIa inhibitors is needed to assess outcomes based on access site alone.
Authors:
Michael S Lee; Michael Wolfe; Gregg W Stone
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  6     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-22     Completed Date:  2014-07-15     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1149-52     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  mortality,  therapy*
Anticoagulants / therapeutic use
Cardiac Catheterization / adverse effects,  methods*,  mortality
Evidence-Based Medicine
Femoral Artery*
Hemorrhage / etiology
Humans
Patient Selection
Percutaneous Coronary Intervention / adverse effects,  methods*,  mortality
Platelet Aggregation Inhibitors / therapeutic use
Radial Artery*
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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