المؤلفون: PETRONIO, ANNA, Valgimigli, Marco, Gagnor, Andrea, Calabró, Paolo, Frigoli, Enrico, Leonardi, Sergio, Zaro, Tiziana, Rubartelli, Paolo, Briguori, Carlo, Andò, Giuseppe, Repetto, Alessandra, Limbruno, Ugo, Cortese, Bernardo, Sganzerla, Paolo, Lupi, Alessandro, Galli, Mario, Colangelo, Salvatore, Ierna, Salvatore, Ausiello, Arturo, Presbitero, Patrizia, Sardella, Gennaro, Varbella, Ferdinando, Esposito, Giovanni, Santarelli, Andrea, Tresoldi, Simone, Nazzaro, Marco, Zingarelli, Antonio, De Cesare, Nicoletta, Rigattieri, Stefano, Tosi, Paolo, Palmieri, Cataldo, Brugaletta, Salvatore, Rao, Sunil V, Heg, Dik, Rothenbühler, Martina, Vranckx, Pascal, Jüni, Peter, MATRIX Investigators

المساهمون: Petronio, Anna, Valgimigli, Marco, Gagnor, Andrea, Calabró, Paolo, Frigoli, Enrico, Leonardi, Sergio, Zaro, Tiziana, Rubartelli, Paolo, Briguori, Carlo, Andò, Giuseppe, Repetto, Alessandra, Limbruno, Ugo, Cortese, Bernardo, Sganzerla, Paolo, Lupi, Alessandro, Galli, Mario, Colangelo, Salvatore, Ierna, Salvatore, Ausiello, Arturo, Presbitero, Patrizia, Sardella, Gennaro, Varbella, Ferdinando, Esposito, Giovanni, Santarelli, Andrea, Tresoldi, Simone, Nazzaro, Marco, Zingarelli, Antonio, De Cesare, Nicoletta, Rigattieri, Stefano, Tosi, Paolo, Palmieri, Cataldo, Brugaletta, Salvatore, Rao, Sunil V, Heg, Dik, Rothenbühler, Martina, Vranckx, Pascal, Jüni, Peter, Matrix, Investigators

مصطلحات موضوعية: Acute Coronary Syndrome, Aged, Blood Loss, Surgical, Catheterization, Peripheral, Cause of Death, Coronary Angiography, Female, Human, Male, Percutaneous Coronary Intervention, Survival Rate, Treatment Outcome, Femoral Artery, Radial Artery, Medicine (all)

الوصف: BACKGROUND: It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management. METHODS: We did a randomised, multicentre, superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segment elevation myocardial infarction who were about to undergo coronary angiography and percutaneous coronary intervention. Patients were randomly allocated (1:1) to radial or femoral access with a web-based system. The randomisation sequence was computer generated, blocked, and stratified by use of ticagrelor or prasugrel, type of acute coronary syndrome (ST-segment elevation myocardial infarction, troponin positive or negative, non-ST-segment elevation acute coronary syndrome), and anticipated use of immediate percutaneous coronary intervention. Outcome assessors were masked to treatment allocation. The 30-day coprimary outcomes were major adverse cardiovascular events, defined as death, myocardial infarction, or stroke, and net adverse clinical events, defined as major adverse cardiovascular events or Bleeding Academic Research Consortium (BARC) major bleeding unrelated to coronary artery bypass graft surgery. The analysis was by intention to treat. The two-sided α was prespecified at 0·025. The trial is registered at ClinicalTrials.gov, number NCT01433627. FINDINGS: We randomly assigned 8404 patients with acute coronary syndrome, with or without ST-segment elevation, to radial (4197) or femoral (4207) access for coronary angiography and percutaneous coronary intervention. 369 (8·8%) patients with radial access had major adverse cardiovascular events, compared with 429 (10·3%) patients with femoral access (rate ratio [RR] 0·85, 95% CI 0·74-0·99; p=0·0307), non-significant at α of 0·025. 410 (9·8%) patients with radial access had net adverse clinical events compared with 486 (11·7%) patients with femoral access (0·83, 95% CI 0·73-0·96; p=0·0092). The difference was ...

وصف الملف: STAMPA

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/25791214; info:eu-repo/semantics/altIdentifier/wos/000356532500021; volume:385; issue:9986; firstpage:2465; lastpage:2476; numberofpages:12; journal:THE LANCET; http://hdl.handle.net/11568/767908Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-84931577241; http://www.sciencedirect.com/science/article/pii/S0140673615602926Test

الإتاحة: https://doi.org/10.1016/S0140-6736Test(15)60292-6
http://hdl.handle.net/11568/767908Test
http://www.sciencedirect.com/science/article/pii/S0140673615602926Test

المؤلفون: Valgimigli, Marco, Gagnor, Andrea, Calabrò, Paolo, Rubartelli, Paolo, Garducci, Stefano, Andò, Giuseppe, Santarelli, Andrea, Galli, Mario, Garbo, Roberto, Bramucci, Ezio, Ierna, Salvatore, Briguori, Carlo, Cortese, Bernardo, Limbruno, Ugo, Violini, Roberto, Presbitero, Patrizia, De Cesare, Nicoletta, Sganzerla, Paolo, Ausiello, Arturo, Tosi, Paolo, Sabate’, Manel, Brugaletta, Salvatore, Saccone, Giovanni, Vandoni, Pietro, Zingarelli, Antonio, Liso, Armando, Rigattieri, Stefano, Di Lorenzo, Emilio, Vigna, Carlo, Palmieri, Cataldo, Falcone, Camillo, De Caterina, Raffaele, Caputo, Marcello, Esposito, Giovanni, Lupi, Alessandro, Mazzarotto, Pietro, Varbella, Fernando, Zaro, Tiziana, Nazzaro, Marco, Rao, Sunil V., Van‘T Hof, Arnoud W. J., Omerovic, Elmir, Uguccioni, Lucia, Tamburino, Corrado, Ferrari, Fabio, Ceravolo, Roberto, Tarantino, Fabio, Casu, Gavino, Cremonesi, Alberto, Saia, Francesco, Guiducci, Vincenzo, Dellavalle, Antonio, Curello, Salvatore, Mangiacapra, Fabio, Evola, Rosario, Liistro, Francesco, Creaco, Manuela, Colombo, Antonio, Perkan, Andrea, De Servi, Stefano, Fischetti, Dionigi, Pucci, Edoardo, Romagnoli, Enrico, Moretti, Claudio, Moretti, Luciano, Turturo, Maurizio, Bonmassari, Roberto, Penzo, Carlo, Loi, Bruno, Mauro, Ciro, Gabrielli, Gabriele, Micari, Antonio, Petronio, Anna Sonia, Comeglio, Marco, Fresco, Claudio, Pasquetto, Giampaolo, Belloni, Flavia, Amico, Francesco, SARDELLA, Gennaro

المساهمون: Valgimigli, Marco, Gagnor, Andrea, Calabrò, Paolo, Rubartelli, Paolo, Garducci, Stefano, Andò, Giuseppe, Santarelli, Andrea, Galli, Mario, Garbo, Roberto, Bramucci, Ezio, Ierna, Salvatore, Briguori, Carlo, Cortese, Bernardo, Limbruno, Ugo, Violini, Roberto, Presbitero, Patrizia, De Cesare, Nicoletta, Sganzerla, Paolo, Ausiello, Arturo, Tosi, Paolo, Sardella, Gennaro, Sabate’, Manel, Brugaletta, Salvatore, Saccone, Giovanni, Vandoni, Pietro, Zingarelli, Antonio, Liso, Armando, Rigattieri, Stefano, Di Lorenzo, Emilio, Vigna, Carlo, Palmieri, Cataldo, Falcone, Camillo, De Caterina, Raffaele, Caputo, Marcello, Esposito, Giovanni, Lupi, Alessandro, Mazzarotto, Pietro, Varbella, Fernando, Zaro, Tiziana, Nazzaro, Marco, Rao, Sunil V., Van‘T Hof, Arnoud W. J., Omerovic, Elmir, Uguccioni, Lucia, Tamburino, Corrado, Ferrari, Fabio, Ceravolo, Roberto, Tarantino, Fabio, Casu, Gavino, Cremonesi, Alberto, Saia, Francesco, Guiducci, Vincenzo, Dellavalle, Antonio, Curello, Salvatore, Mangiacapra, Fabio, Evola, Rosario, Liistro, Francesco, Creaco, Manuela, Colombo, Antonio, Perkan, Andrea, De Servi, Stefano, Fischetti, Dionigi, Pucci, Edoardo, Romagnoli, Enrico, Moretti, Claudio, Moretti, Luciano, Turturo, Maurizio, Bonmassari, Roberto, Penzo, Carlo, Loi, Bruno, Mauro, Ciro, Gabrielli, Gabriele, Micari, Antonio, Petronio, Anna Sonia, Comeglio, Marco, Fresco, Claudio, Pasquetto, Giampaolo, Belloni, Flavia, Amico, Francesco

مصطلحات موضوعية: Acute Coronary Syndrome, Aged, Antithrombin, Europe, Female, Femoral Artery, Human, Male, Middle Aged, Myocardial Infarction, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitor, Platelet Glycoprotein GPIIb-IIIa Complex, Radial Artery, Recombinant Protein, Stroke, Survival Analysi, Treatment Outcome, Heparin, Hirudin, Peptide Fragment, Postoperative Hemorrhage, Cardiology and Cardiovascular Medicine

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/25458646; info:eu-repo/semantics/altIdentifier/wos/WOS:000345506100005; volume:168; issue:6; firstpage:838; lastpage:845; numberofpages:8; journal:AMERICAN HEART JOURNAL; http://hdl.handle.net/11573/913800Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-84912122869; http://www.elsevier.com/inca/publications/store/6/2/3/2/7/2/index.httTest

الإتاحة: https://doi.org/10.1016/j.ahj.2014.08.013Test
http://hdl.handle.net/11573/913800Test
http://www.elsevier.com/inca/publications/store/6/2/3/2/7/2/index.httTest

المؤلفون: Jolly, Sanjit S, Yusuf, Salim, Cairns, John, Niemelä, Kari, Xavier, Denis, Widimsky, Petr, Budaj, Andrzej, Niemelä, Matti, Valentin, Vicent, Lewis, Basil S, Avezum, Alvaro, Steg, Philippe Gabriel, Rao, Sunil V, Gao, Peggy, Afzal, Rizwan, Joyner, Campbell D, Chrolavicius, Susan, Mehta, Shamir R, RIVAL, Dangoisse, Vincent

المساهمون: UCL - (MGD) Service de cardiologie

المصدر: The Lancet, Vol. 377, no.9775, p. 1409-20 (2011)

مصطلحات موضوعية: Acute Coronary Syndrome, Humans, Male, Middle Aged, Myocardial Reperfusion, Radial Artery, Stents, Aged, Angioplasty, Balloon, Coronary, Catheterization, Peripheral, Coronary Angiography, Coronary Artery Bypass, Female, Femoral Artery, Hemorrhage

الوصف: Sanofi-Aventis, Population Health Research Institute, and Canadian Network for Trials Internationally (CANNeCTIN), an initiative of the Canadian Institutes of Health Research.

العلاقة: boreal:126573; http://hdl.handle.net/2078.1/126573Test; info:pmid/21470671; urn:ISSN:0140-6736; urn:EISSN:1474-547X

الإتاحة: https://doi.org/10.1016/S0140-6736Test(11)60404-2
http://hdl.handle.net/2078.1/126573Test

المؤلفون: Jolly, Sanjit S., Cairns, John, Niemela, Kari, Steg, Philippe Gabriel, Natarajan, Madhu K., Cheema, Asim N., Rao, Sunil V., Cantor, Warren J., Džavík, Vladimír, Budaj, Andrzej, Sheth, Tej, Valentin, Vicent, Fung, Anthony, Widimsky, Petr, Ferrari, Emile, Gao, Peggy, Jedrzejowski, Barbara, Mehta, Shamir R.

المصدر: JACC: Cardiovascular Interventions; Mar2013, Vol. 6 Issue 3, p258-266, 9p

مصطلحات موضوعية: RADIOTHERAPY, FEMORAL artery, PERCUTANEOUS coronary intervention, MYOCARDIAL infarction treatment, RANDOMIZED controlled trials, DISEASES

مستخلص: Objectives The authors sought to compare the radiation dose between radial and femoral access. Background Small trials have shown an increase in the radiation dose with radial compared with femoral access, but many were performed during the operators' learning curve of radial access. Methods Patients were randomized to radial or femoral access, as a part of the RIVAL (RadIal Vs. femorAL) trial (N = 7,021). Fluoroscopy time was prospectively collected in 5740 patients and radiation dose quantified as air kerma in 1,445 patients and dose-area product (DAP) in 2,255 patients. Results Median fluoroscopy time was higher with radial versus femoral access (9.3 vs. 8.0 min, p < 0.001). Median air kerma was nominally higher with radial versus femoral access (1,046 vs. 930 mGy, respectively, p = 0.051). Median DAP was not different between radial and femoral access (52.8 Gy-cm 2 vs. 51.2 Gy·cm 2 , p = 0.83). When results are stratified according to procedural volume, air kerma was increased only in the lowest tertile of radial volume centers (low 1,425 vs. 1,045 mGy, p = 0.002; middle 987 vs. 958 mGy, p = 0.597; high 652 vs. 621 mGy, p = 0.403, interaction p = 0.026). Multivariable regression showed procedural volume was the greatest independent predictor of lower air kerma dose (ratio of geometric means 0.55; 95% confidence interval 0.49 to 0.61 for highest-volume radial centers). Conclusions Radiation dose as measured by air kerma was nominally higher with radial versus femoral access, but differences were present only in lower-volume centers and operators. High-volume centers have the lowest radiation dose irrespective of which access site approach that they use. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273 ) [ABSTRACT FROM AUTHOR]

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المؤلفون: Gutierrez, Antonio, Chatzizisis, Yiannis S, Rao, Sunil V

المصدر: Expert Review of Cardiovascular Therapy; Oct2013, Vol. 11 Issue 10, p1271-1273, 3p

مصطلحات موضوعية: CATHETERIZATION, CORONARY artery abnormalities, ANGIOPLASTY, FEMORAL artery, TRANSLUMINAL angioplasty, THERAPEUTICS, DISEASES

مستخلص: The authors reflect on the U.S. catheterization laboratories favoring the transradial approach and increased practice of the technique for coronary angioplasty and intervention in the U.S. They inform that the transradial approach has lower bleeding risk and access site complications as compared to the femoral approach. A graph which discusses progression of transradial approach to percutaneous coronary intervention (PCI) in the U.S. for the period of 2003-2014 is also presented.

المؤلفون: Rao, Sunil V., Turi, Zoltan G., Wong, S. Chiu, Brener, Sorin J., Stone, Gregg W.

المصدر: Journal of the American College of Cardiology (JACC). Oct2013, Vol. 62 Issue 17, pS11-S20. 0p.

مصطلحات موضوعية: *RADIAL artery, *FEMORAL artery, *AORTIC valve diseases, *MYOCARDIAL infarction treatment, *HEMORRHAGE prevention, *PERIPHERAL vascular disease treatment, *THERAPEUTICS, STROKE risk factors

مستخلص: The article offers a comparison between radial artery access and femoral artery access in the treatment of aortic valve disorder. It mentions several risks related to percutaneous coronary intervention (PCI) including myocardial infarction (MI), stent thrombosis and stroke. It also discusses several bleeding avoidance strategies including the use of drug bivalirudin, avoidance of antiplatelet agents and preference of transradial access in obese patients with severe peripheral vascular disease.

المؤلفون: Gargiulo, Giuseppe¹ (AUTHOR) giuseppe.gargiulo1@unina.it, Giacoppo, Daniele^2,3,4 (AUTHOR) giacoppomd@gmail.com, Jolly, Sanjit S.⁵ (AUTHOR) sanjit.jolly@phri.ca, Cairns, John⁶ (AUTHOR) john.cairns@ubc.ca, Le May, Michel⁷ (AUTHOR) mlemay@ottawaheart.ca, Bernat, Ivo⁸ (AUTHOR) ivobernat@gmail.com, Romagnoli, Enrico⁹ (AUTHOR) enromagnoli@gmail.com, Rao, Sunil V.¹⁰ (AUTHOR) rao00010@gmail.com, van Leeuwen, Maarten A.H.¹¹ (AUTHOR) m.a.h.van.leeuwen@isala.nl, Mehta, Shamir R.⁵ (AUTHOR) smehta@mcmaster.ca, Bertrand, Olivier F.¹² (AUTHOR), Wells, George A.⁷ (AUTHOR) gawells@ottawaheart.ca, Meijers, Thomas A.¹¹ (AUTHOR) t.a.meijers@isala.nl, Siontis, George C.M.¹³ (AUTHOR) georgios.siontis@insel.ch, Esposito, Giovanni¹ (AUTHOR) espogiov@unina.it, Windecker, Stephan¹³ (AUTHOR) Stephan.Windecker@insel.ch, Jüni, Peter¹⁴ (AUTHOR) peter.juni@utoronto.ca, Valgimigli, Marco^13,15 (AUTHOR) marco.valgimigli@eoc.ch, Bertand, Olivier F¹⁶ (AUTHOR), Jüni, Peter¹⁷ (AUTHOR)

المصدر: Circulation. 11/1/2022, Vol. 146 Issue 18, p1329-1343. 15p.

مصطلحات موضوعية: *INTRAVENOUS catheterization, *RESEARCH, *CLINICAL trials, *META-analysis, *MEDICAL care, *EVALUATION research, *CARDIOVASCULAR system, *TREATMENT effectiveness, *CORONARY angiography, *FEMORAL artery, *COMPARATIVE studies, *RADIAL artery, *HEMORRHAGE

مستخلص: Background: In some randomized clinical trials, transradial access (TRA) compared with transfemoral access (TFA) was associated with lower mortality in patients with coronary artery disease undergoing invasive management. We analyzed the effects of TRA versus TFA across multicenter randomized clinical trials and whether these associations are modified by patient or procedural characteristics.Methods: We performed an individual patient data meta-analysis of multicenter randomized clinical trials comparing TRA with TFA among patients undergoing coronary angiography with or without percutaneous coronary intervention. The primary outcome was all-cause mortality and the co-primary outcome was major bleeding at 30 days. The primary analysis was conducted by 1-stage mixed-effects models on the basis of the intention-to-treat cohort. The effect of access site on mortality and major bleeding was assessed further by multivariable analysis. The relationship among access site, bleeding, and mortality was investigated by natural effect model mediation analysis with multivariable adjustment.Results: A total of 21 600 patients (10 775 TRA, 10 825 TFA) from 7 randomized clinical trials were included. The median age was 63.9 years, 31.9% were women, 95% presented with acute coronary syndrome, and 75.2% underwent percutaneous coronary intervention. All-cause mortality (1.6% versus 2.1%; hazard ratio, 0.77 [95% CI, 0.63-0.95]; P=0.012) and major bleeding (1.5% versus 2.7%; odds ratio, 0.55 [95% CI, 0.45-0.67]; P<0.001) were lower with TRA. Subgroup analyses for mortality showed consistent results, except for baseline hemoglobin level (Pinteraction=0.003), indicating that the benefit of TRA was substantial in patients with moderate or severe anemia, whereas it was not significant in patients with milder or no baseline anemia. After adjustment, TRA remained associated with 24% and 51% relative risk reduction of all-cause mortality and major bleeding, respectively. A mediation analysis showed that the benefit of TRA on mortality was only partially driven by major bleeding prevention and ancillary mechanisms are required to fully explain the causal association.Conclusions: TRA is associated with lower all-cause mortality and major bleeding at 30 days compared with TFA. The effect on mortality was driven by patients with anemia. The reduction in major bleeding only partially explains the mortality benefit.Registration: URL: https://www.crd.york.ac.uk/prosperoTest; Unique identifier: CRD42018109664. [ABSTRACT FROM AUTHOR]

المؤلفون: Khan, Abdul Ahad¹ (AUTHOR), Panchal, Hemang B.¹ (AUTHOR), Zaidi, Syed Imran M.¹ (AUTHOR), Papireddy, Muralidhar R.¹ (AUTHOR), Mukherjee, Debabrata¹ (AUTHOR), Cohen, Mauricio G.¹ (AUTHOR), Banerjee, Subhash¹ (AUTHOR), Rao, Sunil V.¹ (AUTHOR), Pancholy, Samir¹ (AUTHOR), Paul, Timir K.¹ (AUTHOR) pault@etsu.edu

المصدر: Cardiovascular Revascularization Medicine. Mar2019, Vol. 20 Issue 3, p241-247. 7p.

مصطلحات موضوعية: *ENDARTERECTOMY, *META-analysis, *PERCUTANEOUS coronary intervention, *LENGTH of stay in hospitals, *HOSPITAL mortality, *RADIATION exposure, *INTRAVENOUS catheterization, *INFORMATION storage & retrieval systems, *MEDICAL databases, *OPERATIVE surgery, *SYSTEMATIC reviews, *CORONARY disease, *FEMORAL artery, *RISK assessment, *TREATMENT effectiveness, *RADIAL artery, *CALCINOSIS, *MYOCARDIAL revascularization, *MEDLINE

مستخلص: Introduction: Over the recent years, there has been increased interest in the use of transradial (TR) access for percutaneous coronary intervention (PCI), including rotational atherectomy (RA). However, a large proportion of operators seem to be reluctant to use TR access for complex PCI including rotational atherectomy for heavily calcified coronary lesions.Methods: We searched MEDLINE, ClinicalTrials.gov and the Cochrane Library for studies comparing radial versus femoral access in patients undergoing RA. Studies were included if they reported at least one of the following outcomes in each group separately: major adverse cardiac events (MACE), major bleeding, stent thrombosis, myocardial infarction (MI), hospital length of stay, radiation exposure, procedure time, procedure success and all-cause mortality. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated and a p-value of <0.05 was considered as a level of significance.Results: This meta-analysis included 5 retrospective studies with 3315 patients undergoing RA via radial access and 5838 patients via femoral access. Radial access was associated with lower major access site bleeding (OR: 0.45, 95% CI: 0.31-0.67, p < 0.001), and radiation exposure (MD: -16.1, 95%CI: -25.4--6.7 Gy cm2, p = 0.0007). There were no significant differences observed in all-cause in-hospital mortality (OR: 0.92, 95% CI: 0.69-1.23, p = 0.58); MACE (OR: 0.80, CI: 0.63, 1.02, p = 0.08), stent thrombosis (OR: 0.28, 95%CI: 0.06-1.33 p = 0.11); and MI (OR: 0.43, 95%CI: 0.15-1.24, p = 0.12). There were no significant differences in hospital stay, procedure time or procedure success between the two groups (p > 0.05).Conclusion: This meta-analysis of 9153 patients from observational studies demonstrates similar all-cause mortality, MACE, procedural success and procedural time during RA performed using TR access and TF access. However, TR access was associated with decreased access site bleeding and radiation exposure. Given the observational nature of these findings, a randomized controlled trial is warranted for further evidence. [ABSTRACT FROM AUTHOR]

المؤلفون: Nelson, Daniel W.¹, Banerjee, Subhash², Mayol, Jorge³, Cantor, Warren J.⁴, Rao, Sunil V.⁵, Moscucci, Mauro⁶, Damluji, Abdulla A.⁶, Patel, Nish⁶, Alfonso, Carlos E.⁶, Cohen, Mauricio G.⁶, Valgimigli, Marco⁶, Windecker, Stephan⁶, Byrne, Robert⁶, Nolan, James⁶, Patel, Tejas⁶, Brilakis, Emmanouil⁶

المصدر: Cardiovascular Revascularization Medicine. Mar2018, Vol. 19 Issue 2, p143-150. 8p.

مصطلحات موضوعية: *FEMORAL artery, *PERCUTANEOUS coronary intervention, *PALPITATION, *CARDIOVASCULAR diseases, *CORONARY angiography, *DATA analysis, *SURGERY

مستخلص: Introduction: Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied.Methods: A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016.Results: A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (<50years: 56.4%; ≥50years: 66.8%, p<0.0039) and high PCI volume operators (<100 PCI: 57.3%; 100-299 PCI: 58.7%; ≥300 PCI: 64.3%, p<0.134) preferred palpation only without imaging (fluoroscopy or ultrasound (US)) for TFA. Most respondents preferred not to use micropuncture needle to puncture the femoral artery. Older (≥50years: 64.4%; <50years: 71.5%, p<0.04) and high PCI volume operators (≥300 PCI: 64.1%; 100-299 PCI: 72.6%; <100 PCI: 67.9%, p<0.072) tended not to perform femoral angiography (FA). Of those performing FA, the majority opted to do it at the end of the procedure.Conclusion: Despite best practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging for femoral access or perform femoral angiography during TF procedures. These data highlight opportunities to further reduce TFA complications. [ABSTRACT FROM AUTHOR]

المؤلفون: Mehta, Shamir R.¹ smehta@mcmaster.ca, Jolly, Sanjit S.¹, Cairns, John², Niemela, Kari³, Rao, Sunil V.⁴, Cheema, Asim N.⁵, Steg, Philippe Gabriel⁶, Cantor, Warren J.⁷, Džavík, Vladimír⁸, Budaj, Andrzej⁹, Rokoss, Michael¹, Valentin, Vicent¹⁰, Gao, Peggy¹, Yusuf, Salim¹

المصدر: Journal of the American College of Cardiology (JACC). Dec2012, Vol. 60 Issue 24, p2490-2499. 10p.

مصطلحات موضوعية: *ACUTE coronary syndrome, *FEMORAL artery, *RADIAL artery, *CORONARY angiography, *MYOCARDIAL infarction treatment, *ARTERIAL catheterization, *HEMORRHAGE, *RANDOMIZED controlled trials, *PATIENTS

مستخلص: Objectives: The purpose of this study was to determine the consistency of the effects of radial artery access in patients with ST-segment elevation myocardial infarction (STEMI) and in those with non–ST-segment elevation acute coronary syndrome (NSTEACS). Background: The safety associated with radial access may translate into mortality benefit in higher-risk patients, such as those with STEMI. Methods: We compared efficacy and bleeding outcomes in patients randomized to radial versus femoral access in RIVAL (RadIal Vs femorAL access for coronary intervention trial) (N = 7,021) separately in those with STEMI (n = 1,958) and NSTEACS (n = 5,063). Interaction tests between access site and acute coronary syndrome type were performed. Results: Baseline characteristics were well matched between radial and femoral groups. There were significant interactions for the primary outcome of death/myocardial infarction/stroke/non–coronary artery bypass graft–related major bleeding (p = 0.025), the secondary outcome of death/myocardial infarction/stroke (p = 0.011) and mortality (p = 0.001). In STEMI patients, radial access reduced the primary outcome compared with femoral access (3.1% vs. 5.2%; hazard ratio [HR]: 0.60; p = 0.026). For NSTEACS, the rates were 3.8% and 3.5%, respectively (p = 0.49). In STEMI patients, death/myocardial infarction/stroke were also reduced with radial access (2.7% vs. 4.6%; HR 0.59; p = 0.031), as was all-cause mortality (1.3% vs. 3.2%; HR: 0.39; p = 0.006), with no difference in NSTEACS patients. Operator radial experience was greater in STEMI versus NSTEACS patients (400 vs. 326 cases/year, p < 0.0001). In primary PCI, mortality was reduced with radial access (1.4% vs. 3.1%; HR: 0.46; p = 0.041). Conclusions: In patients with STEMI, radial artery access reduced the primary outcome and mortality. No such benefit was observed in patients with NSTEACS. The radial approach may be preferred in STEMI patients when the operator has considerable radial experience. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273) [Copyright &y& Elsevier]