Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation

Pascal Vranckx
Enrico Frigoli
Martina Rothenbühler
Francesco Tomassini
Stefano Garducci
Giuseppe Andò
Andrea Picchi
Paolo Sganzerla
Anita Paggi
Fabrizio Ugo
Arturo Ausiello
Gennaro Sardella
Nicoletta Franco
Marco Nazzaro
Nicoletta de Cesare
Paolo Tosi
Camillo Falcone
Carlo Vigna
Pietro Mazzarotto
Emilio Di Lorenzo
Claudio Moretti
Gianluca Campo
Carlo Penzo
Giampaolo Pasquetto
Dik Heg
Stephan Windecker
Marco Valgimigli


To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS).


In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI=0.75–1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR=0.80, 95% CI=0.67–0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR=0.86, 95% CI=0.68–1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR=0.82, 95% CI=0.69–0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively).


Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation.

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Eur Heart J. 2017 Apr 7;38(14):1069-1080.