2011 ACC: Radial Access Coronary Intervention Gets High Marks in Multicenter Study

RIVAL study shows radial access for coronary interventions reduces vascular complications.

NEW ORLEANS — April 4, 2011 – Radial access for coronary interventions reduces vascular complications, researchers reported in a late-breaking news conference at the American College of Cardiology’s (ACC) 60th Annual Scientific Session and ACC.i2 Summit.

Sanjit Jolly, MD, assistant professor of medicine at McMaster University in Ontario, Canada, presented results from the “Randomized Comparison of Radial versus Femoral Access for Coronary” study (RIVAL), which was simultaneously published in Lancet.

The multicenter study randomized 7,021 patients to receive either radial access (n=3507) or femoral access (n=3514). Femoral access is performed in 95% of angiography, but emerging research indicates the radial access may cut down on bleeding and improve mortality.

The primary outcome measure was a composite of death, heart attack, stroke, or non-CABG-related bleeding at 30 days. Other outcome measures included angioplasty procedural success and major vascular access site complications at 48 hours and 30 days post-procedure. Both procedures had similar primary outcomes: with 3.7 % and 4.0% of patients experiencing death, heart attack, stroke or non CABG-related major bleeding at 30 days (hazard ratio 0.92; 95% CI.]

Both groups also had similar rates of angioplasty success: 95.4% of patients in the radial access group and 95.2% of patients in the femoral cohort (HR 1.01; 95%).

Radial access performed better, however, when the team examined major vascular complications; 1.4% of patients in the radial access cohort developed this outcome, compared to 3.7% of patients in the femoral group.

Radial access also yielded better results in patients with ST-segment elevation myocardial infarction for the primary outcome measure, and also for mortality.

“The results of RIVAL show that radial access and femoral access are both safe and effective in reducing overall rates of composite of death MI, stroke and non-CABG related major bleeding, but radial access reduced major complications compared with femoral access, with similar PCI success rates,” Jolly said.

The relative difficulty of learning the radial access procedure may be a barrier to wider adoption. However, the study authors noted in their report that “the effectiveness of radial access might be linked to expertise and volume.”

The study was funded by Sanofi-Aventis, the Population Health Research Institutes of Health and the Canadian Network and Center for Trials International. Jolly received institutional research grants from Sanofi-Aventis, Bristol MyersSquibb and Medtronic and consulting feed from Sanofi-Aventis, GlaxoSmithKline and AstraZeneca