Radial versus femoral access for elderly patients with acute coronary syndrome undergoing coronary angiography and intervention: insights from the RIVAL trial

Background Radial access for percutaneous coronary intervention is associated with lower rates of access site complications and bleeding. However, elderly patients have more complex vascular anatomy and radial access may be more challenging in this population. There remains uncertainty regarding the...

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Published in:The American heart journal 2015-11, Vol.170 (5), p.880-886
Main Authors: Cantor, Warren J., MD, Mehta, Shamir R., MD, MSC, Yuan, Fei, MMath, Džavík, Vladimír, MD, Worthley, Matthew, MD, Niemelä, Kari, MD, PHD, Valentin, Vicent, MD, Fung, Anthony, MD, Cheema, Asim N., MD, PHD, Widimsky, Petr, MD, Natarajan, Madhu, MD, Jedrzejowski, Barbara, MEng, Jolly, Sanjit S., MD, MSC
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnostic imaging
Acute Coronary Syndrome - surgery
Acute coronary syndromes
Aged
Cardiology
Cardiovascular
Catheterization, Peripheral - methods
Catheters
Clinical outcomes
Coronary Angiography - methods
Female
Femoral Artery
Heart attacks
Humans
Male
Percutaneous Coronary Intervention - methods
Radial Artery
Treatment Outcome
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Summary:Background Radial access for percutaneous coronary intervention is associated with lower rates of access site complications and bleeding. However, elderly patients have more complex vascular anatomy and radial access may be more challenging in this population. There remains uncertainty regarding the role of radial access in elderly patients undergoing cardiac catheterization. Methods and Results The RIVAL trial randomized patients with acute coronary syndromes undergoing cardiac catheterization to radial versus femoral access. In this analysis, the rates of access site complications and access site cross-over were compared across different age groups. Among the 7,021 patients, 1035 (15%) were ≥75 years of age. Across all age categories, radial access was consistently associated with higher rates of access site cross over and lower rates of major access site complications, with no significant interaction between age and access site. Radial access was associated with lower rates of major vascular access site complications in patients ≥75 years of age (3.6% vs 6.6%; P = .03) and in patients
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2015.08.011