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Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART
Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
Lund Univ, Dept Cardiol, Lund, Sweden.
Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
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2019 (English)In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 6, p. 510-519Article in journal (Refereed) Published
Abstract [en]

Aims: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. Methods and results: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801). Conclusions: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. Vol. 8, no 6, p. 510-519
Keywords [en]
Acute coronary syndrome, anticoagulants, antithrombins, femoral artery, haemorrhage, heparin, hirudins, peptide fragments, percutaneous coronary intervention, radial artery, recombinant proteins
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-394694DOI: 10.1177/2048872618817217ISI: 000484942800004PubMedID: 31237158OAI: oai:DiVA.org:uu-394694DiVA, id: diva2:1362028
Funder
Swedish Research CouncilSwedish Foundation for Strategic Research Available from: 2019-10-17 Created: 2019-10-17 Last updated: 2019-10-17Bibliographically approved

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Sarno, GiovannaJames, Stefan

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UCR-Uppsala Clinical Research CenterDepartment of Medical SciencesCardiology
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