Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Percutaneous coronary intervention (PCI) is a cornerstone in managing acute coronary syndromes (ACS).
• Vascular access site selection (radial vs. femoral) can significantly impact procedural safety and patient outcomes.
• The Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme investigated these differences.

Purpose of the Study:

• To compare the efficacy and safety of radial versus femoral access in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
• To determine if the choice of access site influences major adverse cardiovascular events (MACE) and net adverse clinical events (NACE).

Main Methods:

• A randomized trial involving patients with STEMI and NSTE-ACS.
• Patients were stratified and randomized to either radial or femoral access.
• Co-primary outcomes assessed at 30 days included MACE (death, myocardial infarction, stroke) and NACE (MACE or major bleeding).

Main Results:

• Radial access significantly reduced NACE in the overall population (P=0.023 for NSTE-ACS).
• While MACE did not reach statistical significance for the primary endpoint in NSTE-ACS (P=0.016), trends favored radial access.
• Radial access demonstrated a consistent benefit in reducing all-cause mortality and access site-related bleeding across both STEMI and NSTE-ACS patient groups.

Conclusions:

• Radial access offers consistent clinical benefits in patients with ACS, irrespective of STEMI or NSTE-ACS presentation.
• The findings support radial access as a preferred strategy for PCI due to improved safety and reduced adverse events.
• The MATRIX program confirms the safety and efficacy of radial access in a broad ACS population.