Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Data From the Randomized MATRIX-Access Trial.

Gargiulo, Giuseppe; Ariotti, Sara; Vranckx, Pascal; Leonardi, Sergio; Frigoli, Enrico; Ciociano, Nestor; Tumscitz, Carlo; Tomassini, Francesco; Calabrò, Paolo; Garducci, Stefano; Crimi, Gabriele; Andò, Giuseppe; Ferrario, Maurizio; Limbruno, Ugo; Cortese, Bernardo; Sganzerla, Paolo; Lupi, Alessandro; Russo, Filippo; Garbo, Roberto; Ausiello, Arturo; ... (2018). Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Data From the Randomized MATRIX-Access Trial. JACC. Cardiovascular Interventions, 11(1), pp. 36-50. Elsevier 10.1016/j.jcin.2017.09.014

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OBJECTIVES This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management. BACKGROUND There are limited and contrasting data about sex disparities for the safety and efficacy of TRA versus TFA for coronary intervention. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) program, 8,404 patients were randomized to TRA or TFA. The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACCE or major bleeding. RESULTS Among 8,404 patients, 2,232 (26.6%) were women and 6,172 (73.4%) were men. MACCE and NACE were not significantly different between men and women after adjustment, but women had higher risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p = 0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR: 0.56; p = 0.0089). When comparing radial versus femoral, there was no significant interaction for MACCE and NACE stratified by sex (pint = 0.15 and 0.18, respectively), although for both coprimary endpoints the benefit with TRA was relatively greater in women (RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly, there was no significant interaction between male and female patients for the individual endpoints of all-cause death (pint = 0.79), myocardial infarction (pint = 0.25), stroke (pint = 0.18), and Bleeding Academic Research Consortium type 3 or 5 (pint = 0.45). CONCLUSIONS Women showed a higher risk of severe bleeding and access site complications, and radial access was an effective method to reduce these complications as well as composite ischemic and ischemic or bleeding endpoints.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Gargiulo, Giuseppe; Ariotti, Sara; Frigoli, Enrico; Windecker, Stephan; Da Costa, Bruno and Valgimigli, Marco

Subjects:

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

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

11 Jan 2018 15:41

Last Modified:

22 Jan 2018 09:04

Publisher DOI:

10.1016/j.jcin.2017.09.014

PubMed ID:

29301646

Uncontrolled Keywords:

MATRIX acute coronary syndrome(s) female femoral access male radial access

BORIS DOI:

10.7892/boris.108972

URI:

https://boris.unibe.ch/id/eprint/108972

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