title: Radial versus femoral access for elderly patients with acute coronary syndrome undergoing coronary angiography and intervention: insights from the RIVAL trial.
abstract: BACKGROUND
  Radial access for percutaneous coronary intervention is associated with lower rates of access site complications and bleeding. However, elderly patients have more complex vascular anatomy and radial access may be more challenging in this population. There remains uncertainty regarding the role of radial access in elderly patients undergoing cardiac catheterization.
  
  
  RESULTS
  The RIVAL trial randomized patients with acute coronary syndromes undergoing cardiac catheterization to radial versus femoral access. In this analysis, the rates of access site complications and access site cross-over were compared across different age groups. Among the 7,021 patients, 1035 (15%) were ≥75 years of age. Across all age categories, radial access was consistently associated with higher rates of access site cross over and lower rates of major access site complications, with no significant interaction between age and access site. Radial access was associated with lower rates of major vascular access site complications in patients ≥75 years of age (3.6% vs 6.6%; P = .03) and in patients <75 years of age (1.0% vs 3.2%; P < .001; P value for interaction = .2). The rates of access site crossover were higher with radial access among patients ≥75 (12.5% vs 2.6%; P < .001) and <75 (6.7% vs 1.9%; P < .001; P value for interaction = .9). There were no significant differences in the primary composite outcome (death, myocardial infarction, stroke or non coronary artery bypass graft major bleeding) or its individual components in either age group. In patients ≥75 years of age undergoing primary percutaneous coronary intervention, there was no significant difference in procedure time (120 vs 115 minutes; P = .3).
  
  
  CONCLUSIONS
  Consistent with the overall RIVAL trial population, elderly patients undergoing cardiac catheterization have lower rates of major bleeding or access site complications and higher rates of access site crossover with radial access compared to femoral access.
authors.affiliation: Southlake Regional Health Centre, Newmarket, ON, Canada. Electronic address: cantorw@rogers.com.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Fei
authors.initials: F
authors.lastname: Yuan
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.affiliation: University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Worthley
authors.affiliation: Tampere University Hospital and Heart Center, Tampere, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.affiliation: Hospital Universitari Dr Peset, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Valentin
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fung
authors.affiliation: St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
authors.affiliation: Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Madhu
authors.initials: M
authors.lastname: Natarajan
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Jedrzejowski
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D016896:Treatment Outcome