Subanalysis of EUROMAX Compares Impact of Arterial Access Sites on PCI Outcomes

July 6, 2015—A study on the impact of arterial access site on outcomes after primary percutaneous coronary intervention (PCI) was published by Martial Hamon, MD, et al in Circulation: Cardiovascular Interventions. The study is currently available online.

The investigators conducted a prespecified subgroup analysis from the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial that assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin. The EUROMAX trial had shown that bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparin plus optional glycoprotein IIb/IIIa inhibitors. 

As summarized in Circulation: Cardiovascular Interventions, the choice of arterial access was left to operator discretion in the EUROMAX trial, in which 47% and 53% of patients underwent radial and femoral access procedures, respectively. Baseline risk was higher in the femoral access group. Unadjusted proportions for the primary outcome (death or noncoronary artery bypass graft protocol major bleeding at 30 days) were lower with radial access, but there was no difference in major or major plus minor bleeding. 

The investigators reported that after multivariable adjustment, ischemic outcomes were similar between access site groups, except for a lower risk of stroke in patients in the radial group. Bivalirudin was associated with lower proportions of the primary outcome in both the radial and the femoral groups. Bleeding was significantly lower in the bivalirudin group, both in radial- and femoral-treated patients, but no significant difference was observed in ischemic outcomes. In multivariable analysis, bivalirudin emerged as the only independent predictor of reduced major bleeding.

In this prespecified analysis from EUROMAX, radial access was preferred in lower-risk patients and did not improve clinical outcomes. Additionally, bivalirudin was associated with less bleeding irrespective of access site, concluded the investigators in Circulation: Cardiovascular Interventions.