Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management
Felice Gragnano1, Mattia Branca2, Enrico Frigoli2
1Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy.
Insights
Access-site crossover in acute coronary syndrome patients undergoing invasive procedures did not significantly increase major adverse cardiovascular events (MACE) or net adverse clinical events (NACE). However, radial-to-femoral crossover negated bleeding benefits, while femoral-to-radial crossover increased MACE and NACE risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Limited data exist on the clinical implications of access-site crossover in patients with acute coronary syndrome (ACS).
- Understanding crossover impacts is crucial for optimizing invasive management strategies.
Purpose of the Study:
- To assess the impact of access-site crossover on clinical outcomes in ACS patients undergoing invasive procedures.
- To compare outcomes between radial and femoral access with and without crossover.
Main Methods:
- Analysis of 8,404 ACS patients from the MATRIX-Access trial randomized to radial or femoral access.
- Investigation of outcomes in patients undergoing access-site crossover versus successful access.
- Coprimary outcomes at 30 days: composite of death, myocardial infarction, or stroke (MACE) and MACE or Bleeding Academic Research Consortium (BARC) type 3/5 bleeding (NACE).
Main Results:
- Radial crossover (4.4%) was mainly to femoral access; femoral crossover (2.6%) was mainly to radial access.
- Radial crossover did not significantly increase MACE or NACE compared to successful radial or femoral access.
- Femoral crossover was associated with significantly higher risks of MACE and NACE compared to successful femoral access.
- Radial crossover was associated with higher access site-related BARC 3/5 bleeding compared to successful radial access.
Conclusions:
- Crossover from radial to femoral access eliminates the bleeding advantage of radial access but does not increase MACE or NACE.
- Femoral crossover significantly increases risks for MACE and NACE.
- These findings highlight the importance of successful initial access site selection in ACS management.
Objectives:
The aim of this study was to assess the impact of access-site crossover in patients with acute coronary syndrome undergoing invasive management via radial or femoral access.
Background:
There are limited data on the clinical implications of access-site crossover.
Methods:
In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox)-Access trial, 8,404 patients with acute coronary syndrome were randomized to radial or femoral access. Patients undergoing access-site crossover or successful access site were investigated. Thirty-day coprimary outcomes were a composite of death, myocardial infarction, or stroke (major adverse cardiovascular events [MACE]) and a composite of MACE or Bleeding Academic Research Consortium type 3 or 5 bleeding (net adverse clinical events [NACE]).
Results:
Access-site crossover occurred in 183 of 4,197 patients (4.4%) in the radial group (mainly to femoral access) and 108 of 4,207 patients (2.6%) in the femoral group (mainly to radial access). In multivariate analysis, the risk for coprimary outcomes was not significantly higher with radial crossover compared with successful radial (MACE: adjusted rate ratio [adjRR]: 1.25; 95% confidence interval [CI]: 0.81 to 1.93; p = 0.32; NACE: adjRR: 1.40; 95% CI: 0.94 to 2.06; p = 0.094) or successful femoral access (MACE: adjRR: 1.17; 95% CI: 0.76 to 1.81; p = 0.47; NACE: adjRR: 1.26; 95% CI: 0.86 to 1.86; p = 0.24). Access site-related Bleeding Academic Research Consortium type 3 or 5 bleeding was higher with radial crossover than successful radial access. Femoral crossover remained associated with higher risks for MACE (adjRR: 1.84; 95% CI: 1.18 to 2.87; p = 0.007) and NACE (adjRR: 1.69; 95% CI: 1.09 to 2.62; p = 0.019) compared with successful femoral access. Results remained consistent after excluding patients with randomized access not attempted.
Conclusions:
Crossover from radial to femoral access abolishes the bleeding benefit offered by the radial over femoral artery but does not appear to increase the risk for MACE or NACE compared with successful radial or femoral access. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox [MATRIX]; NCT01433627).
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