Читать книгу Interventional Cardiology - Группа авторов - Страница 312

According to current ESC and AHA/ACC guidelines, use of transradial access during primary PCI should be preferred, if performed by an experienced radial operator [3,4]. This is supported by the results of the RIVAL trial [6], which randomized 7021 patients with acute coronary syndrome (ACS) to either radial or femoral access. The hazard ratio for the primary outcome of death, myocardial infarction, stroke or non‐coronary artery bypass graft (CABG) related bleeding at 30 days in the radial group was 0.92 (95% CI 0.72–1.17; p = 0.50) but with a significant interaction with benefit for radial access in the highest volume radial centers (HR 0.49; 95% CI 0.28–0.87; p = 0.015) and specifically, in STEMI (HR 0.60; 95% CI 0.38–0.94; p = 0.026). The RIFLE‐STEACS trial [7], randomized 1001 STEMI patients to either radial or femoral access at four high volume centers, and found that radial access was associated with significantly lower rates of cardiac mortality (5.2% vs 9.2%, p = 0.020) and bleeding (7.8% vs 12.2%, p = 0.026). The MATRIX trial [8], confirmed this finding for a cohort of 8404 ACS patients including 48% STEMI, revealing a rate ratio for Bleeding Academic Research Consortium (BARC) major bleeding unrelated to CABG of 0.67 (95% CI 0.49–0.92; p = 0.013) for radial access, as well as a rate ratio for all‐cause mortality of 0.72 (95% CI 0.53–0.99; p = 0.045).