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Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the RIVAL Trial (Radial Vs femorAL access for coronary intervention).

Publication ,  Journal Article
Pandie, S; Mehta, SR; Cantor, WJ; Cheema, AN; Gao, P; Madan, M; Niemela, K; Rao, SV; Schwalm, JD; Valentin, V; Velianou, JL; Jolly, SS
Published in: JACC Cardiovasc Interv
April 20, 2015

OBJECTIVES: The purpose of this study was to determine the efficacy and safety of radial versus femoral access in women undergoing coronary angiography/intervention. BACKGROUND: The risk of bleeding and vascular access site complications are higher in women than in men. METHODS: In a pre-specified RIVAL (RadIal Vs femorAL access for coronary intervention) subgroup analysis, we compared outcomes in women (n=1,861) and men (n=5,160) randomized to radial versus femoral access. RESULTS: Overall, women were at higher risk of major vascular complications compared with men (4.7% vs. 1.7%; p<0.0001). Major vascular complications were significantly reduced with radial access in women (3.1% vs. 6.1%; hazard ratio [HR]: 0.5; 95% confidence interval [CI]: 0.32 to 0.78; p=0.002) and in men (0.7% vs. 2.8%; HR: 0.27; 95% CI: 0.17 to 0.45; p<0.0001; interaction p=0.092). Crossover rates were higher with radial compared with femoral access in women (11.1% vs. 1.9%; HR: 5.88; p<0.0001) and men (6.3% vs. 1.9%; HR: 3.32; p<0.0001; interaction p=0.054). Percutaneous coronary intervention (PCI) success rates were similar irrespective of access site (women: HR: 1.05; p=0.471; men: HR: 1.00; p=0.888; interaction p=0.674), with no differences in PCI complications. In multivariable analyses, female sex was an independent predictor of major vascular complications (HR: 2.39; 95% CI: 1.76 to 3.25; p<0.0001). There were consistent findings for women and men, with no difference for the primary composite endpoint of death, myocardial infarction, stroke, and non-coronary artery bypass grafting bleeding (women: 3.9% vs. 5.0%; HR: 0.77; 95% CI: 0.50 to 1.19; men: 3.54% vs. 3.5%; HR: 1.00; 95% CI: 0.75 to -1.34; interaction p=0.325). CONCLUSIONS: Women undergoing coronary angiography and PCI have a higher risk of vascular access site complications compared with men, and radial access is an effective method to reduce these complications.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

April 20, 2015

Volume

8

Issue

4

Start / End Page

505 / 512

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Sex Factors
  • Severity of Illness Index
  • Risk Assessment
  • Radial Artery
  • Proportional Hazards Models
  • Percutaneous Coronary Intervention
  • Multivariate Analysis
  • Middle Aged
 

Citation

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Pandie, S., Mehta, S. R., Cantor, W. J., Cheema, A. N., Gao, P., Madan, M., … Jolly, S. S. (2015). Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the RIVAL Trial (Radial Vs femorAL access for coronary intervention). JACC Cardiovasc Interv, 8(4), 505–512. https://doi.org/10.1016/j.jcin.2014.11.017
Pandie, Shaheen, Shamir R. Mehta, Warren J. Cantor, Asim N. Cheema, Peggy Gao, Mina Madan, Kari Niemela, et al. “Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the RIVAL Trial (Radial Vs femorAL access for coronary intervention).JACC Cardiovasc Interv 8, no. 4 (April 20, 2015): 505–12. https://doi.org/10.1016/j.jcin.2014.11.017.
Pandie, Shaheen, et al. “Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the RIVAL Trial (Radial Vs femorAL access for coronary intervention).JACC Cardiovasc Interv, vol. 8, no. 4, Apr. 2015, pp. 505–12. Pubmed, doi:10.1016/j.jcin.2014.11.017.
Pandie S, Mehta SR, Cantor WJ, Cheema AN, Gao P, Madan M, Niemela K, Rao SV, Schwalm JD, Valentin V, Velianou JL, Jolly SS. Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the RIVAL Trial (Radial Vs femorAL access for coronary intervention). JACC Cardiovasc Interv. 2015 Apr 20;8(4):505–512.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

April 20, 2015

Volume

8

Issue

4

Start / End Page

505 / 512

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Sex Factors
  • Severity of Illness Index
  • Risk Assessment
  • Radial Artery
  • Proportional Hazards Models
  • Percutaneous Coronary Intervention
  • Multivariate Analysis
  • Middle Aged