Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management

Gargiulo, Giuseppe; Ariotti, Sara; Vranckx, Pascal; Leonardi, Sergio; Frigoli, Enrico; Ciociano, Nestor; Tumscitz, Carlo; Tomassini, Francesco; Calabrò, Paolo; Garducci, Stefano; Crimi, Gabriele; Andò, Giuseppe; Ferrario, Maurizio; Limbruno, Ugo; Cortese, Bernardo; Sganzerla, Paolo; Lupi, Alessandro; Russo, Filippo; Garbo, Roberto; Ausiello, Arturo; Zavalloni, Dennis; Sardella, Gennaro; Esposito, Giovanni; Santarelli, Andrea; Tresoldi, Simone; Nazzaro, Marco Stefano; Zingarelli, Antonio; Petronio, Anna Sonia; Windecker, Stephan; Costa, Bruno R. da; Valgimigli, Marco

doi:10.1016/j.jcin.2017.09.014

Cited by 48 publications

(32 citation statements)

References 21 publications

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“…A recent MATRIX sub‐study confirmed that women have a higher risk of severe bleeding and access site complications in the setting of ACS. Radial access was an effective method to reduce these complications, as well as impacting on the composite ischemic, and ischemic or bleeding endpoints …”

Section: Discussionmentioning

confidence: 99%

Sex differences in procedural and clinical outcomes following rotational atherectomy

Ford

Khan

Docherty

et al. 2019

Cathet Cardio Intervent

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Aim: Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA).Methods and Results: From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001).

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Section: Discussionmentioning

confidence: 99%

Sex differences in procedural and clinical outcomes following rotational atherectomy

Ford

Khan

Docherty

et al. 2019

Cathet Cardio Intervent

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“…RAA is considered to be a component of a “bleeding avoidance” strategy that may also include ultrasound guided arterial cannulation, and avoidance of GPIIb/IIIa inhibitors . The use of RAA has been steadily increasing as operators become more comfortable with this technique with some studies reporting 50% radial access use . However, in some studies, RAA is used less in women compared to men, and women are more likely to have access site crossover with an initial RAA approach .…”

Section: Introductionmentioning

confidence: 99%

“…3 The use of RAA has been steadily increasing as operators become more comfortable with this technique with some studies reporting 50% radial access use. 7,8 However, in some studies, RAA is used less in women compared to men, 7,9 and women are more likely to have access site crossover with an initial RAA approach. 8 To further understand what factors impact access site selection, we sought to determine the frequency and predictors of RAA use in patients undergoing PCI at a single center over a 10-year period.…”

mentioning

confidence: 99%

Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry

Chester

Mina

Lewis

et al. 2019

Cathet Cardio Intervent

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Background Women may benefit from radial artery access (RAA) for percutaneous coronary interventions (PCI) due to a higher risk of bleeding compared to men; however, RAA may be underutilized in women. We sought to determine the frequency and predictors of RAA use in patients undergoing PCI. Methods We studied 21,123 (29.0% female) participants in the Mayo Clinic PCI Registry from January 1, 2006–December 31, 2016. Data were analyzed as a cohort and by time tertiles. Frequency of RAA versus femoral access and bleeding events were recorded. Logistic regression was used to identify predictors of RAA. Results In the overall cohort, women compared to men were older (69.6 ± 12.6 vs. 65.6 ± 11.9; p < .001), more likely to present with acute coronary syndrome (82.0% in women vs. 80.0% in men; p = .0008) and had more comorbidities. RAA increased from tertile one (3.5% for women vs. 4.0% for men; p = .3) through tertile three (46.8% for women vs. 50.3% for men; p = .01), but remained lower in women. In multivariable analysis, female sex is associated with 22% less RAA use (OR 0.78, 95% CI 0.72–0.84; p < .0001). Women compared to men experienced more bleeding (6.3 vs. 3.0%; p < .0001) but bleeding was less likely in RAA (OR 0.45, 95% CI 0.36–0.56; p < .0001). Conclusion Women undergoing PCI are less likely to receive RAA compared to men despite having a higher risk of bleeding. This trend persists despite increase in RAA use. Given the potential benefit of RAA in women, sex should be considered in patient selection for RAA.

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“…[70,71] One of these, the MATRIX trial, enrolled 8,404 patients (26.7% women) and specifically evaluated the impact of sex. [72] After adjustment, the overall adverse event rate was not significantly different for men versus women, however women still had an overall higher risk of access-site bleeding (RR 0.64; p=0.0016), severe bleeding (RR 0.17; p=0.0012) and need for transfusion (RR 0.56; p=0.0089). The benefit of trans-radial access in reducing MACE was more evident in women than in men and was statistically significantly (RR 0.73; 95% CI [0.56–0.95]; p=0.019) compared with the use of a femoral approach.…”

Section: Peri-procedural Complicationsmentioning

confidence: 99%

Outcomes After Percutaneous Coronary Intervention in Women: Are There Differences When Compared with Men?

Rao

Hoye

2019

Interv Cardiol

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Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management

Abstract: Women showed a higher risk of severe bleeding and access site complications, and radial access was an effective method to reduce these complications as well as composite ischemic and ischemic or bleeding endpoints.

Cited by 48 publications

References 21 publications

Sex differences in procedural and clinical outcomes following rotational atherectomy

Sex differences in procedural and clinical outcomes following rotational atherectomy

Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry

Outcomes After Percutaneous Coronary Intervention in Women: Are There Differences When Compared with Men?

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