Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management : A prespecified subgroup analysis from VALIDATE-SWEDEHEART
(2019) In European Heart Journal: Acute Cardiovascular Care 8(6). p.510-519- Abstract
AIMS: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin.
METHODS AND RESULTS: A total of 6006 patients with acute coronary syndrome... (More)
AIMS: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin.
METHODS AND RESULTS: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801).
CONCLUSIONS: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.
(Less)
- author
- Völz, Sebastian
; Angerås, Oskar
; Koul, Sasha
LU
; Haraldsson, Inger
; Sarno, Giovanna
; Venetsanos, Dimitrios
; Grimfärd, Per
; Ulvenstam, Anders
; Hofmann, Robin
; Hamid, Mehmet
; Henareh, Loghman
; Wagner, Henrik
; Jensen, Jens
; Danielewicz, Mikael
; Östlund, Ollie
; Eriksson, Peter
; Scherstén, Fredrik
LU
; Linder, Rickard
; Råmunddal, Truls
; Pétursson, Pétur
; Fröbert, Ole
; James, Stefan
; Erlinge, David
LU
and Omerovic, Elmir
(Less) - organization
- publishing date
- 2019-09-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Heart Journal: Acute Cardiovascular Care
- volume
- 8
- issue
- 6
- pages
- 510 - 519
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85110853124
- pmid:31237158
- ISSN
- 2048-8734
- DOI
- 10.1177/2048872618817217
- language
- English
- LU publication?
- yes
- id
- dc5649c7-7f23-4689-893d-57a26d328923
- date added to LUP
- 2020-06-16 11:58:35
- date last changed
- 2024-05-17 22:30:35
@article{dc5649c7-7f23-4689-893d-57a26d328923,
abstract = {{<p>AIMS: In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin.</p><p>METHODS AND RESULTS: A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801).</p><p>CONCLUSIONS: Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.</p>}},
author = {{Völz, Sebastian and Angerås, Oskar and Koul, Sasha and Haraldsson, Inger and Sarno, Giovanna and Venetsanos, Dimitrios and Grimfärd, Per and Ulvenstam, Anders and Hofmann, Robin and Hamid, Mehmet and Henareh, Loghman and Wagner, Henrik and Jensen, Jens and Danielewicz, Mikael and Östlund, Ollie and Eriksson, Peter and Scherstén, Fredrik and Linder, Rickard and Råmunddal, Truls and Pétursson, Pétur and Fröbert, Ole and James, Stefan and Erlinge, David and Omerovic, Elmir}},
issn = {{2048-8734}},
language = {{eng}},
month = {{09}},
number = {{6}},
pages = {{510--519}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal: Acute Cardiovascular Care}},
title = {{Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management : A prespecified subgroup analysis from VALIDATE-SWEDEHEART}},
url = {{http://dx.doi.org/10.1177/2048872618817217}},
doi = {{10.1177/2048872618817217}},
volume = {{8}},
year = {{2019}},
}