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

Vranckx, Pascal; Frigoli, Enrico; Rothenbühler, Martina; Tomassini, Francesco; Garducci, Stefano; Andò, Giuseppe; Picchi, Andrea; Sganzerla, Paolo; Paggi, Anita; Ugo, Fabrizio; Ausiello, Arturo; Sardella, Gennaro; Franco, Nicoletta; Nazzaro, Marco; de Cesare, Nicoletta; Tosi, Paolo; Falcone, Camillo; Vigna, Carlo; Mazzarotto, Pietro; Di Lorenzo, Emilio; ... (2017). Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation. European Heart Journal, 38(14), pp. 1069-1080. Oxford University Press 10.1093/eurheartj/ehx048

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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).

Methods and results

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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Rothenbühler, Martina, Heg, Dierik Hans, Windecker, Stephan, Valgimigli, Marco


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Oxford University Press




Tanya Karrer

Date Deposited:

05 Sep 2017 15:39

Last Modified:

05 Dec 2022 15:06

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Femoral; MATRIX; NSTE-ACS; Radial; STEMI





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