title: Impact of arterial access site on outcomes after primary percutaneous coronary intervention: prespecified subgroup analysis from the EUROMAX trial.
abstract: BACKGROUND
  In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin.
  
  
  RESULTS
  In EUROMAX, choice of arterial access was left to operator discretion. Overall, 47% of patients underwent radial and 53% femoral access. Baseline risk was higher in the femoral access group. Unadjusted proportions for the primary outcome (death or noncoronary artery bypass graft protocol major bleeding at 30 days) were lower with radial access, however, without differences in major or major plus minor bleeding proportions. After multivariable adjustment, ischemic outcomes were no longer different between access site groups, except for a lower risk of stroke in radial patients. Bivalirudin was associated with lower proportions of the primary outcome in both the radial (odds ratio, 0.58; 95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95% CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly lower in the bivalirudin group both in the radial- and femoral-treated patients but no significant difference was observed in ischemic outcomes. In multivariable analysis, bivalirudin emerged as the only independent predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74; P=0.002).
  
  
  CONCLUSIONS
  In this prespecified analysis from EUROMAX, radial access was preferred in lower risk patients and did not improve clinical outcomes. Bivalirudin was associated with less bleeding irrespective of access site.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01087723.
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.). hamon-m@chu-caen.fr.
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Arnoud
authors.initials: A
authors.lastname: Van't Hof
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Jurrien
authors.initials: J
authors.lastname: Ten Berg
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Xavier
authors.initials: X
authors.lastname: Tabone
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Steen D
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Vojko
authors.initials: V
authors.lastname: Kanic
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Debra
authors.initials: D
authors.lastname: Bernstein
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Prodromos
authors.initials: P
authors.lastname: Anthopoulos
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Efthymios N
authors.initials: EN
authors.lastname: Deliargyris
authors.affiliation: From the Department of Clinical Research, University of Caen, Caen, France (M.H.); Department of Cardiology, Hôpital Cardiologique-Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, Pessac, France (P. Coste); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A.v.H.); Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.T.B.); Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (P. Clemmensen); Department of Cardiology, Hôpital Jacques Coeur, Bourges, France (X.T.); Department of Cardiology, Hôpital de la Roseraie, Aubervilliers, France (H.B.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.D.K.); Department of Cardiology, S.Maria della Misericordia University Hospital, Perugia, Italy (C.C.); Department of Cardiology, Emodinamica, Cardiologia Azienda Ospedaliero-Universitaria, Bologna, Italy (A.M.); Department of Cardiology, Kerckhoff Clinic and Thoraxcenter, Bad Nauheim, Germany (C.H.); Department of Cardiology, University Medical Centre Maribor, Maribor, Slovenia (V.K.); The Medicines Company, Parsippany, NJ (D.B., P.A., E.N.D.); Université Paris-Diderot, Sorbonne Paris Cité, INSERM Unité-1148, Département Hospitalo-Universitaire Fibrosis Inflammation Remodeling, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); French Alliance for Cardiovascular Trials, Paris, France (P.G.S.); and National Heart Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.).
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006470:Hemorrhage / Q000139:chemically induced; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017534:Radial Artery / Q000601:surgery*; D011994:Recombinant Proteins / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: bivalirudin; hemorrhage; myocardial infarction; percutaneous coronary intervention