title: 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).
abstract: OBJECTIVE
  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.
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Pandie
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada.
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada.
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.affiliation: Sunnybrook Health Science Centre, Toronto, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Madan
authors.affiliation: Tampere University Hospital and Heart Centre, Tampere, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Niemela
authors.affiliation: Duke University Medical Centre, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada.
authors.forename: Jon David
authors.initials: JD
authors.lastname: Schwalm
authors.affiliation: Hospital Universitari Dr. Peset, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Valentin
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Science, Hamilton, Ontario, Canada. Electronic address: sanjit.jolly@phri.ca.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: PCI; radial access; women