RIVAL: More favorable outcomes documented for radial vs. femoral access

American College of Cardiology 60th Annual Scientific Sessions

NEW ORLEANS — New data presented here from the largest randomized trial to date comparing radial and femoral access for coronary angiography and intervention have revealed radial access to be superior in vascular complications while still leading to a similar success rate compared with femoral access.

The international, multicenter RIVAL trial was designed to help answer the question as to which access site is the most optimal for coronary angiography and intervention in patients with acute coronary syndromes. The trial included 7,021 patients who were randomized to receive either radial (n=3,507) or femoral (n=3,514) access. Investigators defined the primary outcome as incidence of death, MI, stroke or non-CABG-related major bleeding at 30 days.

At follow-up, both access sites produced comparable results in the primary outcome (radial, 3.7% vs. femoral, 4%; P=.50). Similarly, angiographic success rates were even between arms (radial, 95.4% vs. femoral, 95.2%; P=.83).

Significant differences, however, were reported with major vascular access site complications, which favored the radial cohort (1.4% vs. 3.7%; P<.001). These complications, according to Sanjit S. Jolly, MD, study investigator and assistant professor of medicine, McMaster University, Hamilton, Ontario, Canada, in a press conference, included large hematomas at the access site, pseudoaneurysms, arteriovenous fistulas as well as other vascular site surgical repair.

“The implications for practice [of this study] are that both approaches are safe and effective in the coronary,” he said. “We believe that the more you do the better you get, which is an important phenomenon [showing] that volume is important, particularly in radial access. And, finally, both patients and physicians may end up choosing the radial approach because of its similar efficacy and reduced vascular complications.” – by Brian Ellis

Disclosure: Dr. Jolly has received consulting fees/honoraria from AstraZeneca, GlaxoSmithKline and Sanofi-Aventis and has received research grants from Sanofi-Aventis, Bristol-Myers Squibb and Medtronic. The trial was funded in part by Sanofi-Aventis.

For more information:

Jolly S. LBCT III, Session 3014. Presented at: ACC 60th Annual Scientific Sessions; April 2-5, 2011; New Orleans.

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