Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation.
To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS).



In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI = 0.75-1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67-0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68-1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69-0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively).



Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation.
Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium.
Pascal
P
Vranckx
EUSTRATEGY Association, Forli' (FC), Italy.
Enrico
E
Frigoli
Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
Martina
M
Rothenbühler
Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Str. del Barocchio, 25, 10095 Turin, Italy.
Francesco
F
Tomassini
Ospedale Civile di Vimercate (MB), Via Santi Cosma e Damiano, 10, 20871 Vimercate MB, Italy.
Stefano
S
Garducci
Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Via Consolare Valeria, 1, 98125 Messina ME , Italy.
Giuseppe
G
Andò
UO Cardiologia, ASL 9 Grosseto, Via Senese - Grosseto; 58100 Grosseto, Italy.
Andrea
A
Picchi
AO Ospedale Treviglio-Caravaggio, Piazzale Ospedale, 1, 24047 Treviglio BG, Italy.
Paolo
P
Sganzerla
Azienda Ospedaliera Sant'Anna, Via Ravona, 20, 22020 San fermo della battaglia Como, Italy.
Anita
A
Paggi
San Giovanni Bosco Hospital, Piazza del Donatore di Sangue, 3, 10154 Turin, Italy.
Fabrizio
F
Ugo
Casa di Cura Villa Verde, Via Golfo di Taranto, 22, 74121 Taranto, Italy.
Arturo
A
Ausiello
Policlinico Umberto I, "Sapienza" University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy.
Gennaro
G
Sardella
Cardiovascular Department, Infermi Hospital, Viale Luigi Settembrini, 2, 47900 Rimini, Italy.
Nicoletta
N
Franco
San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy.
Marco
M
Nazzaro
Policlinico San Marco, Corso Europa, 7, 24040 Zingonia, Osio Sotto BG, Italy.
Nicoletta
N
de Cesare
Mater Salutis Hospita, Via Carlo Gianella, 37045 Legnago VR, Italy.
Paolo
P
Tosi
Osepdale Sacra Famiglia Fatebenefratelli, Erba, Fatebenefratelli, 22036 Como CO, Italy.
Camillo
C
Falcone
Casa Sollievo della Sofferenza, San Giovanni Rotodondo Foggia, Viale Cappuccini, 1, 71013 San Giovanni Rotondo FG, Italy.
Carlo
C
Vigna
Ospedale di Lodi, Strada Provinciale 19, 1, 26866 Sant'Angelo Lodigiano LO, Italy.
Pietro
P
Mazzarotto
Ospedale San Giuseppe Moscati, Contrada Amoretta, 83100 Avellino AV, Italy.
Emilio
E
Di Lorenzo
A.O.U. San Giovanni Battista Molinette di Torino, Corso Bramante, 88, 10126 Turin Italy.
Claudio
C
Moretti
Azienda Ospedaliera Universitaria di Ferrara, Via Aldo Moro, 8, 44124 Ferrara FE, Italy.
Gianluca
G
Campo
Ospedale Civile di Mirano, Via Zinelli, 30035 Mirano Venezia VE, Italy.
Carlo
C
Penzo
Ospedali Riuniti Padova Sud, SR10var, 35043 Monselice PD.
Giampaolo
G
Pasquetto
Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
Dik
D
Heg
Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and Department of Medicine, University of Toronto, Bond Street 30, ON M5B1W8, Toronto, Canada.
Peter
P
Jüni
Swiss Cardiovascular Center Bern, Bern University Hospital Freiburgstrasse 8, 3010 Bern, Switzerland (M.V.; S.W.) and Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Stephan
S
Windecker
Swiss Cardiovascular Center Bern, Bern University Hospital Freiburgstrasse 8, 3010 Bern, Switzerland (M.V.; S.W.) and Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Marco
M
Valgimigli
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D017534:Radial Artery; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome
Femoral ; MATRIX ; NSTE-ACS; Radial ; STEMI 