title: Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.
abstract: OBJECTIVE
  Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions.
  
  
  RESULTS
  A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX.
  
  
  CONCLUSIONS
  The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000991:Antithrombins / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002309:Cardiology; D005263:Femoral Artery; D006629:Hirudins; D006801:Humans; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D011994:Recombinant Proteins / Q000627:therapeutic use; D012955:Societies, Medical; D011795:Surveys and Questionnaires
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin