Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest

Autor: Sergio Leonardi, Enrico Frigoli, Felice Gragnano, Giovanni Esposito, Alberto Ranieri De Caterina, Pascal Vranckx, Marco Valgimigli, Paolo Calabrò, Negar Manavifar, Roberto Galea, Stephan Windecker, Lukas Hunziker, Alessandro Spirito, Mikael Sunnåker, Giuseppe Gargiulo
Přispěvatelé: Gargiulo, Giuseppe, Valgimigli, Marco, Sunnåker, Mikael, Vranckx, Pascal, Frigoli, Enrico, Leonardi, Sergio, Spirito, Alessandro, Gragnano, Felice, Manavifar, Negar, Galea, Roberto, De Caterina, Alberto R, Calabrò, Paolo, Esposito, Giovanni, Windecker, Stephan, Hunziker, Lukas, University of Zurich
Rok vydání: 2020
Předmět:
Acceso radial
medicine.medical_specialty
Acute coronary syndrome
medicine.drug_class
Radial acce
610 Medicine & health
Insuficiencia cardiaca aguda
030204 cardiovascular system & hematology
Antithrombins
11171 Cardiocentro Ticino
2705 Cardiology and Cardiovascular Medicine
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Internal medicine
Parada cardiaca
medicine
Humans
Bivalirudin
Bivalirudina
Síndrome coronario agudo
Vulnerable patients
Myocardial infarction
Stroke
Killip class
Paciente vulnerable
Heparin
business.industry
Anticoagulant
Anticoagulants
Acute heart failure
General Medicine
Hirudins
Cardiac arrest
medicine.disease
Peptide Fragments
Recombinant Proteins
Treatment Outcome
Cardiology
Number needed to treat
business
Out-of-Hospital Cardiac Arrest
Mace
medicine.drug
Zdroj: Revista Española de Cardiología (English Edition). 73:893-901
ISSN: 1885-5857
DOI: 10.1016/j.rec.2020.01.005
Popis: Introduction and objectives Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited. We assessed outcomes of transradial vs transfemoral access and bivalirudin vs unfractionated heparin (UFH) in VP with acute coronary syndrome undergoing invasive management. Methods The MATRIX trial randomized 8404 patients to radial or femoral access and 7213 patients to bivalirudin or UFH. Among them, 934 (11.1%) were deemed VP due to advanced Killip class (n = 808), cardiac arrest (n = 168), or both (n = 42). The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACE: death, myocardial infarction, or stroke) and net adverse clinical events (NACE: MACE or major bleeding). Results MACE and NACE were similarly reduced with radial vs femoral access in VP and non-VP. Transradial access was also associated with consistent relative benefits in all-cause and cardiovascular mortality or Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding with greater absolute benefits in VP. The effects of bivalirudin vs UFH on MACE and NACE were consistent in VP and non-VP. Bivalirudin was associated with lower all-cause and cardiovascular mortality in VP but not in non-VP, with borderline interaction testing. Bivalirudin reduced bleeding in both VP and non-VP with a larger absolute benefit in VP. Conclusions In acute coronary syndrome patients undergoing invasive management, the effects of randomized treatments were consistent in VP and non-VP, but absolute risk reduction with radial access and bivalirudin were greater in VP, with a 5- to 10-fold lower number needed to treat for benefits. Trial registry number: NCT01433627.
Databáze: OpenAIRE
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