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EUROMAX: Femoral, radial access for primary PCI yielded similar outcomes
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Patients who underwent primary PCI via radial access had comparable 30-day outcomes to those treated via femoral access, according to results from a prespecified subanalysis of the EUROMAX study.
Arterial access choice also did not influence the effect of bivalirudin (Angiomax, The Medicines Company) on bleeding risk in these patients, the researchers wrote.
Among 2,152 patients enrolled in EUROMAX with available access site data, 47% underwent radial access and 53% underwent femoral access. The researchers noted that the choice of arterial access was at the discretion of the operator, and that patients treated via femoral access had higher baseline risk profiles than those in the radial access group.
The primary outcome of EUROMAX was a composite of mortality or non-CABG-related major bleeding at 30 days. Results from unadjusted analysis indicated that this outcome was less common in the radial access arm. However, proportions of major bleeding or major plus minor bleeding did not differ between groups. Multivariable analysis indicated similar risk for ischemic events between the groups, with the exception of reduced risk for stroke in the radial access arm (OR = 0.19; 95% CI, 0.05-0.67).
Bivalirudin use lowered the risk for major bleeding in both the radial access (OR = 0.54; 95% CI, 0.28-1.05) and femoral access (OR = 0.35; 95% CI, 0.19-0.65) arms. Bivalirudin was also associated with reduced incidence of the primary endpoint compared with heparins and optional glycoprotein IIb/IIIa inhibitors in both the radial (OR = 0.58; 95% CI, 0.33-1.03) and femoral (OR = 0.59; 95% CI, 0.37-0.93) access groups. The researchers wrote that this outcome was driven primarily by reduced bleeding with bivalirudin because no significant differences were reported between the groups with regard to mortality and MACE.
Results from logistic regression analysis indicated that bivalirudin use was independently predictive of reduced bleeding risk (OR = 0.45; 95% CI, 0.27-0.74), while access site was not, the researchers wrote.
“In this prespecified subgroup analysis from the contemporary EUROMAX trial, radial access for primary PCI was more commonly preferred in lower risk patients,” they concluded. “Adjusted clinical outcomes, including bleeding, were comparable between patients treated via radial or femoral access.” – by Rob Volansky
Disclosure: The Medicines Company funded the EUROMAX trial. The researchers report associations with a number of device and pharmaceutical companies. Please see the full study for a list of all other authors’ relevant financial disclosures.
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