Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score.

Gragnano, Felice; Jolly, Sanjit S; Mehta, Shamir R; Branca, Mattia; van Klaveren, David; Frigoli, Enrico; Gargiulo, Giuseppe; Leonardi, Sergio; Vranckx, Pascal; Di Maio, Dario; Monda, Emanuele; Fimiani, Luigi; Fioretti, Vincenzo; Chianese, Salvatore; Andò, Giuseppe; Esposito, Giovanni; Sangiorgi, Giuseppe Massimo; Biondi-Zoccai, Giuseppe; Heg, Dik; Calabrò, Paolo; ... (2021). Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EuroIntervention, 17(12), e971-e980. Europa Digital & Publishing 10.4244/EIJ-D-21-00441

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The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover.


We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively.


The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively.


The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover.


The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Branca, Mattia, Frigoli, Enrico, Heg, Dierik Hans, Windecker, Stephan, Valgimigli, Marco


600 Technology > 610 Medicine & health




Europa Digital & Publishing




Doris Kopp Heim

Date Deposited:

20 Aug 2021 10:04

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


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