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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EThe MATRIX trial in patients with acute coronary syndrome who were being managed invasively found that transradial access reduced the occurrence of a net composite end point that included bleeding and efficacy, as well as death and major bleeding, when compared with transfemoral access. Bivalirudin did not reduce the occurrence of either of the co-primary composite end points, but exploratory analyses found that death and bleeding were reduced with bivalirudin when compared with unfractionated heparin.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute coronary syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary angiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMATRIX trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous coronary intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etransfemoral\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etransradial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT01433627\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EThe MATRIX trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01433627\u0026amp;atom=%2Fspmdc%2F15%2F5%2F9.atom\u0022\u003ENCT01433627\u003C\/a\u003E] was performed in patients with acute coronary syndrome (ACS) who underwent coronary angiography, percutaneous coronary intervention (PCI), or both, and the trial was designed to determine the optimal access site and anticoagulation strategy. There were no differences between transradial (TR) and transfemoral (TF) access with regard to the primary efficacy end point, but TR access reduced mortality and major bleeding [Valgimigli M et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2015]. In addition, there were no differences in the incidence of the primary end point between bivalirudin and unfractionated heparin (UFH); however, bivalirudin reduced death and major bleeding. The findings from both programs were presented by the principal investigator, Marco Valgimigli, MD, PhD, Erasmus Medical Center, Rotterdam, The Netherlands.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003ECompared with the femoral artery, the radial artery\u2019s superficial location and smaller caliber allow better hemostasis, but the use of radial arterial catheterization can be more technically challenging to perform, Prof Valgimigli said. Because previous trials had reached differing conclusions, it was unclear whether TR access improved outcomes in patients with ACS who were managed invasively when compared with TF access [Hsieh V, Jolly S. \u003Cem\u003EJ Comp Eff Res.\u003C\/em\u003E 2013; Michael TT et al. \u003Cem\u003EJACC Cardiovasc Interv\u003C\/em\u003E. 2013].\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EA second unresolved question in this patient population was which antithrombotic regimen most effectively prevented ischemic complications while limiting bleeding risk. Previous studies comparing bivalirudin and UFH used with or without glycoprotein IIb\/IIIa inhibitors had also produced conflicting results [Abtahian F et al. \u003Cem\u003ECatheter Cardiovasc Interv.\u003C\/em\u003E 2015; Capodanno D et al. \u003Cem\u003EEur Heart J Acute Cardiovasc Care\u003C\/em\u003E. 2015].\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EMATRIX was a phase 3, prospective, randomized, open-label trial conducted at 78 sites in Italy, The Netherlands, Spain, and Sweden. Participants, recruited between October 2011 and November 2014, were randomized in a 2-step process. In the MATRIX Access Site program, 8404 patients with ACS who were candidates for coronary angiography and PCI were randomly assigned to TR access (n\u2005=\u20054197) or TF access (n\u2005=\u20054207). In the MATRIX Antithrombin program, patients (n\u2005=\u20057213) who underwent PCI were then randomly assigned to anticoagulation with UFH (n\u2005=\u20053603) or bivalirudin (n\u2005=\u20053610).\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EPrimary and secondary end points were identical in both programs; co-primary end points were major adverse cardiovascular events (MACEs), a composite of death, myocardial infarction (MI), and stroke at 30 days; and net adverse clinical events (NACEs), a composite of MACEs plus major bleeding (BARC 3 or 5) at 30 days. Secondary end points were each component of the co-primary end points; any bleeding as measured by the BARC, TIMI, or GUSTO scales; and stent thrombosis.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EParticipants in the Access Site program were \u0026gt;\u200570% men, with a mean age of 67; 30% were aged \u2265\u200575 years; 48% had a diagnosis of STEMI; 46%, NSTEMI; and 6%, unstable angina. Participants in the Antithrombin program were \u0026gt;\u200575% men, with a mean age of 65; 25% were aged \u2265\u200575 years; 55% had a diagnosis of STEMI; 40%, NSTEMI; and \u0026lt;\u20055%, unstable angina.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EInterventional cardiologists conducting study procedures were required to have performed a total of at least 75 TR coronary interventions and performed at least 50% of all their interventional procedures by the TR route during the year preceding initiation of the MATRIX study.\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EAmong patients in the Access Site program, 8.8% of the TR group experienced the co-primary end point MACEs compared with 10.3% of the TF group (rate ratio [RR], 0.85; 95% CI, 0.74 to 0.99; 2-sided \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.031). The \u003Cem\u003EP\u003C\/em\u003E value was considered nonsignificant at the prespecified \u03b1 of 0.025 that was utilized given the 2 primary comparisons of the trial. In the TR group, 9.8% of participants met the NACEs end point vs 11.7% of those in the TF group, which was statistically significant (RR, 0.83; 95% CI, 0.73 to 0.96; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.009). The factors contributing to this outcome were statistically significant differences in death (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) and major bleeding (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E), in favor of the TR approach.\u003C\/p\u003E\n\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16213\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16213\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16213\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EAccess Site Program: All-Cause Mortality\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16214\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16214\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16214\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EAccess Site Program: Bleeding End Points\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-14\u0022\u003EIn the Antithrombin program, there were no statistically significant differences between the UFH and bivalirudin groups for either of the co-primary end points (MACEs, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.45; NACEs, \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.122). Rates of all-cause mortality were significantly reduced in the bivalirudin group compared with the UFH group at 30 days (1.7% vs 2.3%; RR, 0.71; 95% CI, 0.51 to 0.99; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.042). Bleeding risk was also significantly reduced in the bivalirudin group, across all scales and including fatal events and nonaccess site events (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16215\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16215\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16215\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EAntithrombin Program: Results for All Bleeding End Points\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-17\u0022\u003EOne possible explanation for the finding that the co-primary composite end point of neither trial was met despite significant reductions in mortality and bleeding is that the MI rate was much higher than expected and there were no differences in the rates of MI between the 2 groups, Prof Valgimigli said.\u003C\/p\u003E\n\u003Cp id=\u0022p-18\u0022\u003EIn conclusion, the MATRIX trial found that TR access reduced the occurrence of NACEs, which was 1 of 2 co-primary composite end points, and it reduced all-cause mortality and major bleeding when compared to TF access. Bivalirudin did not reduce the occurrence of either of the co-primary composite end points, but exploratory analyses found that death and bleeding were reduced with bivalirudin when compared with UFH.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/5\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl6u1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzl6u1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}