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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\u003Cp id=\u0022p-1\u0022\u003EThe RIVAL study demonstrated that the transradial approach for percutaneous coronary intervention was as safe and effective as the transfemoral but was associated with a lower rate of vascular complications. Importantly, the effectiveness of the transradial approach was related to procedure volume and previous experience. The Czech PCI Registry found that the incidence of 30-day death was lower with the transradial approach in patients with STEMI and NSTEMI.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etransradial approach\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etransfemoral approach\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous coronary intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERIVAL\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT01014273\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eunstable angina\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute coronary syndromes\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESTEMI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery bypass graft\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EPetr Kala, MD, PhD, Masaryk University and University Hospital Brno, Brno, Czech Republic, shared data from A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention (PCI) Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01014273\u0026amp;atom=%2Fspmdc%2F14%2F16%2F6.atom\u0022\u003ENCT01014273\u003C\/a\u003E], demonstrating that the transradial approach (TRA) and the transfemoral approach (TFA) are both safe and effective for PCI. TRA reduced the rate of vascular complications; however, the effectiveness of TRA is linked to the volume and prior expertise.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Prof Kala, TFA has traditionally been the primary route of arterial access for cardiac catheterization. TRA represents an alternative access site that has some advantages over femoral access. Because of decreased vascular and bleeding complications, both the American College of Cardiology Foundation\/American Heart Association guidelines on PCI [Levine GN et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2011] and the European Society of Cardiology guidelines on management of acute coronary syndromes (ACSs) in patients Non-STE ACS support the use of TRA by experienced operators when feasible [Hamm CW et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe RIVAL trial was the largest study to compare the efficacy and safety of the TRA with TFA in patients being treated with an invasive strategy for an ACS [Jolly SS et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2011]. In this multicenter, randomized, parallel-group study, between June 6, 2006 and November 3, 2010, patients (n = 7021) with an ACS were randomized to either TRA (n = 3507) or TFA (n = 3514). In order to be included, patients had to have intact dual circulation of the hand. The procedures were performed by interventional cardiologists experienced in both techniques. The primary end point of the trial was the composite of death, myocardial infarction (MI), stroke, or non\u2013coronary artery bypass grafting (CABG)-related major bleeding at 30 days.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe results of the study showed that there was no statistical difference in the rate of the primary end point between TRA and TFA groups (3.7% vs 4.0%; \u003Cem\u003EP\u003C\/em\u003E = .50). TRA decreased major vascular complications (1.4% vs 3.7%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001). Access site crossover was higher in the TRA group (7.6% vs 2.0%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001). In subgroup analyses, rates of primary outcome also appeared to be lower in the TRA group in high-volume radial centers (\u003Cem\u003EP\u003C\/em\u003E = .021) and STEMI (\u003Cem\u003EP\u003C\/em\u003E = .025; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Subgroups Analyses for the Primary Outcome\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-780504883\u0022 data-figure-caption=\u0022Subgroups Analyses for the Primary Outcome\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16923\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\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ESubgroups Analyses for the Primary Outcome\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EBMI, body mass index; CABG, coronary artery bypass graft; MI, myocardial infarction; NSTE\/ACS, non\u2013ST-segment elevation acute coronary syndrome; PCI, percutaneous coronary intervention.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from \u003Cem\u003EThe Lancet\u003C\/em\u003E, 377. Jolly SS et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. 1409\u20131420. Copyright 2011, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EProf Kala discussed the current state of TRA for PCI in the Czech Republic. He presented unpublished data from the Czech PCI Registry in the National Register of Cardiovascular Interventions containing information from all PCI procedures (\u0026gt; 100 000) that were performed in the country since 2005. The use of TRA has been increasing annually and was used in 70% of PCI cases in 2013 [Kala P. \u003Cem\u003EESC Proceedings\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe registry was used to compare data and outcomes associated with use of the TRA and TFA. As compared to patients treated with TFA, patients in whom TRA was used had a lower incidence of prior MI (27% vs 30%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), PCI (11% vs 13%; \u0026lt; 0.001), heart failure (7.3% vs 6.6%; \u003Cem\u003EP\u003C\/em\u003E = .002), and CABG. Patients treated with TRA had lower rates of death at 30 days (2% vs 3%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001). Interestingly, Prof Kala noted that this difference in all-cause mortality was significant for in patients with STEMI (1% vs 3%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and non-ST segment elevation. Prof Kala concluded by noting that these data suggest that the TRA is feasible in patients undergoing PCI, including those with ACS.\u003C\/p\u003E\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\/14\/16\/6.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_figures.js?nzljw1\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_openurl.js?nzljw1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}