Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the Rival Trial

Pandie, Shaheen; Mehta, S.; Gao, Peng; Cantor, Warren J.; Cheema, Asim N.; Madden, Marie; Velianou, James L.; Schwalm, Jon-David; Jolly, Sanjit S.

doi:10.1016/j.cjca.2014.07.103

Cited by 21 publications

(37 citation statements)

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“…Table 1 depicted the characteristics of the studies included. There were 1 registry-based RCT, 7 3 post hoc analyses of RCTs, [8][9][10] and 11 observational studies. [11][12][13][14][15][16][17][18][19][20][21] All of these studies recruited patients with acute coronary syndrome (ACS), whereas 9 studies enrolled patients with non-ACS as well.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies 7,8,[13][14][15]17,19,20 evaluated the association between vascular access and bleeding complications in women (100 208 TRI vs 1 146 468 TFI) and men (270 333 TRI vs 2 333 445 TFI). Meta-analysis of these data demonstrated TRI-versus-TFI ORs of 0.37 (95% confidence interval [CI]: 0.29-0.46) and 0.47 (95% CI: 0.40-0.55; interaction P ¼ .07) in favor of the TRI group for women and men, respectively ( Figure 2A).…”

Section: Bleeding Complicationsmentioning

confidence: 99%

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Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention

Huang

Wang

et al. 2016

Angiology

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Our aim was to investigate the gender disparity in the safety and efficacy of transradial percutaneous coronary intervention (PCI; TRI) and transfemoral PCI (TFI) by a meta-analysis. MEDLINE, Embase, and CENTRAL were searched to identify studies on vascular access with sex-specific events available or studies on sex difference with the events reported by vascular access. Fifteen studies involving 3 921 848 participants were included. Transradial PCI significantly reduced the risk of bleeding complications in both sexes (TRI-versus-TFI odds ratio [OR]: 0.37 in females vs 0.47 in males) and major adverse cardiac events (MACE) in females (OR: 0.70, P < .001) but not in males (OR: 0.83, P = .15) compared to TFI. Transradial PCI diminished the sex difference in the incidence of bleeding complications (female-versus-male OR: 1.82 with TRI vs 2.39 with TFI; interaction P = .01) and MACE (female-versus-male OR: 1.21 with TRI vs 1.41 with TFI; interaction P = .003) compared to TFI. Females were associated with higher crossover rate in the TRI subgroup but not in the TFI subgroup (interaction P = .05). In conclusion, TRI may improve the safety and efficacy of outcomes in both sexes and be an effective means to cut down the gender difference in prognosis.

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Section: Resultsmentioning

confidence: 99%

Section: Bleeding Complicationsmentioning

confidence: 99%

Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention

Huang

Wang

et al. 2016

Angiology

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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%

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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“…Bleeding and vascular complications are higher in women and are independent of baseline variables. Bleeding (and vascular complications) are associated with advanced age, lower body weight, and overdosing of anticoagulant medications, all of which are more common in women than men.…”

mentioning

confidence: 99%

Sex and Outcomes After Percutaneous Coronary Intervention: A Cause for Concern for Young Women and Those With ST‐Segment Elevation Myocardial Infarction?

Tamis-Holland

2017

JAHA

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Radial Versus Femoral Access for Coronary Angiography/Intervention in Women With Acute Coronary Syndromes: Insights From the Rival Trial

Cited by 21 publications

References 0 publications

Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention

Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention

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

Sex and Outcomes After Percutaneous Coronary Intervention: A Cause for Concern for Young Women and Those With ST‐Segment Elevation Myocardial Infarction?

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