The new MATRIX trial, recently published in JACC Interv., shows that an access-site crossover from radial to femoral access in patients with acute coronary syndrome cancels out the benefit provided by radial access as regards bleeding.
However, there are no signs of comparative damage between successfully conducted radial or femoral access as a first attempt.
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. There are precise data regarding radial and femoral access; however, there is limited information regarding cases when an access-site crossover is needed.
In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial, a total of 8404 patients with acute coronary syndrome were randomized to radial or femoral access.
Researchers compared results of patients with successful access and those who required access-site crossover. The study had two endpoints: on the one hand, a composite of death, myocardial infarction, and stroke at 30 days, and, on the other hand, a composite of major Bleeding Academic Research Consortium (BARC) type 3 to 5, death, myocardial infarction, and stroke (net medical adverse events).
Access-site crossover occurred in 183 of 4197 patients (4.4%) in the radial group (to femoral access), and 108 of 4207 patients (2.6%) in the femoral group (to radial access).
In multivariate analysis, the risk for the composite of events was not significantly higher when comparing successful radial or femoral access with access-site crossover from radial to femoral access. Patients who underwent access-site crossover from radial to femoral access lost the benefit related to major bleeding.
Patients undergoing access-site crossover from femoral to radial access showed higher rates of adverse events (risk ratio [RR]: 1.84; 95% confidence interval [CI]: 1.18 to 2.87; p = 0.007) and higher rates of net medical adverse events (RR: 1.69; 95% CI: 1.09 to 2.62; p = 0.019) than patients who had undergone successful femoral access.
Conclusion
An access-site crossover from radial to femoral access leaves patients without the benefit provided by radial access regarding bleeding; however, it does not cause increased death, myocardial infarction, or stroke rates.
Original Title: Access-Site Crossover in Patients With Acute Coronary Syndrome Undergoing Invasive Management.
Reference: Felice Gragnano et al. J Am Coll Cardiol Cardiovasc Interv. 2021 Feb, 14 (4) 361–373.
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