Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial

Jolly, Sanjit S.; Yusuf, Salim; Cairns, John A.; Niemelä, Kari; Xavier, Denis; Widimský, Petr; Budaj, Andrzej; Niemelä, Matti; Valentín, Vicent; Lewis, Basil S.; Avezum, Álvaro; Steg, Philippe Gabriel; Rao, Sunil V.; Gao, Peggy; Afzal, Rizwan; Joyner, Campbell; Chrolavicius, Susan; Mehta, Shamir R.

doi:10.1016/s0140-6736(11)60404-2

Cited by 1,803 publications

(1,328 citation statements)

References 20 publications

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“…Previous studies have shown radial access to be associated with many benefits, such as reductions in bleeding rates and major vascular complications 37, 38, 39, 40, 41, 42, 43. It is also the patient‐preferred arterial access site44, 45 and associated with lower cost 34, 36.…”

Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

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Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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“…However, a weak point of the radial approach has been shown to be longer D2B time than that of femoral approach [10,11]. Difficulty in puncture, spasm of radial artery, different engagement method for guiding catheters, and arterial anomalies of upper limb artery [20] are reasons for the longer D2B time.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the radial approach in primary PCI has revealed significant clinical benefits in reducing bleeding events and morbidity compared with the femoral approach; however, D2B time with the radial approach was longer than with the femoral approach [10,11]. Shortening D2B time using the radial approach would be one way to improve STEMI patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction

Torii

Fujii

Murakami

et al. 2016

Cardiovasc Interv and Ther

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The purpose of this study is to determine reduction of door-to-balloon (D2B) time using a single universal guiding catheter (Ikari-Left catheter) in transradial approach. In this procedure, we can skip a total of five steps compared with a conventional procedure (two catheter insertions, two catheter removals, and one catheter engagement). Reducing total ischemic time is important to achieving a better outcome in primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). We retrospectively compared 30 consecutive STEMI patients who underwent transradial primary PCI with a single guiding catheter (IL group) with 30 consecutive patients with conventional transradial primary PCI. Patients with cardiogenic shock, heart failure, or need for intra-aortic balloon pumping support before primary PCI were excluded. Baseline characteristics were not different between the two groups. The D2B time was significantly shorter in the IL group (55 ± 16 vs. 63 ± 17 min, respectively; p = 0.01). Puncture-to-balloon time was also significantly shorter in the IL group (15 ± 11 min vs. 25 ± 11 min, respectively; p = 0.001). The total number of diagnostic and guiding catheters was significantly less in IL group (1 (IQR 1-1) vs. 3 (IQR 3-3), respectively; p \ 0.0001). Primary PCI with a single universal guiding catheter reduced D2B time by skipping several procedural steps, and reduced the total number of catheters needed. This technique could reduce patient mortality as well as total medical cost.

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“…7 Transradial access (TRA) has been shown to reduce access site-related bleeding, vascular complications, and mortality after PCI. [8][9][10] Although a reduction in bleeding with TRA may translate to a mortality benefit, factors other than bleeding may play a role.…”

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confidence: 99%

Radial Versus Femoral Access Is Associated With Reduced Complications and Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction

Iqbal

Arujuna

Ilsley

et al. 2014

Circ: Cardiovascular Interventions

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456P ercutaneous coronary intervention (PCI) for ST-segmentelevation myocardial infarction and an early invasive strategy, which may include PCI, for non-ST-segmentelevation acute coronary syndrome (NSTEACS) are associated with improved clinical outcomes. 1,2 Such patients receive multiple adjunctive antithrombotic therapies, which increase bleeding risk. In acute coronary syndromes, bleeding is a significant predictor of morbidity and mortality. 3 Although access-site complications represent an important source of bleeding, especially when transfemoral access (TFA) is used, 4-6 in NSTEACS, access-site bleeding accounts for a smaller proportion of bleeding events compared with Background-Compared with transfemoral access, transradial access (TRA) for percutaneous coronary intervention is associated with reduced risk of bleeding and vascular complications. Studies suggest that TRA may reduce mortality in patients with ST-segment-elevation myocardial infarction. However, there are few data on the effect of TRA on mortality, specifically, in patients with non-ST-segment-elevation myocardial infarction.

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Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial

Cited by 1,803 publications

References 20 publications

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction

Radial Versus Femoral Access Is Associated With Reduced Complications and Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction

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