acceso en el stemi radial vs femoral · 2016-06-10 · acceso en el stemi radial vs femoral dr...

V SIMPOSIO del CONSEJO de HEMODINAMIA SAC 2015

Mas alla de las Fronteras del Intervencionismo Cardiovascular

ACCESO en el STEMI RADIAL vs FEMORAL Dr Cesar Pardinas Montevideo Uruguay

LA VIA TRANSRADIAL DEBERIA SER EL ACCESO DE ELECCION o ldquo DEFAULTrdquo PARA LOS PACIENTES CON SCA TRATADOS CON INTERVENCIONISMO PERCUTANEO

Cine frame from the first selective coronary arteriogram recorded by F Mason Sones Jr on

October 30 1958

Cheng T O Circulation 2003107e42

Copyright copy American Heart Association Inc All rights reserved

EDUCATIONAL CONTENT ENDORSED BY EAPCI A REGISTERED BRANCH

OF THE EUROPEAN SOCIETY OF CARDIOLOGY

Figure 1

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The PCR-EAPCI Textbook ndash Percutaneous interventional cardiovascular medicine

Vascular access Olivier Bertrand Rodney de Palma David Meerkin



Figure 6

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Procedimientos INCC 2014

N 1455

Acceso radial en el tratamiento intervencionista del infarto agudo de miocardio con sobreelevacioacuten del ST Dr Gabriel Pintos INCC

OBJETIVO Evaluar los resultados obtenidos en el tratamiento intervencionista de pacientes con IAMcST realizado por acceso radial

MEacuteTODO Estudio analiacutetico de cohorte

Desde el 01012003 hasta el 31122009 se trataron 2114 pacientes con IAMcST en curso (lt24 hs de evolucioacuten) Se incluyeron en la base de datos de la institucioacuten y se registroacute prospectivamente

bull Comorbilidad bull Procedimiento realizado bull Tipo y nuacutemero de arterias tratadas bull Dispositivos utilizados bull Evolucioacuten pos procedimiento inmediata

0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177

Incidencia del acceso radial en IAMcST seguacuten eacutepoca

SUPERVIVENCIA SEGUacuteN ACCESO VASCULAR

p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES

El ACCESO RADIAL se asocioacute a disminucioacuten del riesgo de

MUERTE a corto y largo plazo en el tratamiento intervencionista

del IAMcST y por tanto PODRIA SER LA VIA DE ABORDAJE DE

ELECCION EN ESTOS PACIENTES

Adoption of Radial Access in PCI in US Trend in the Use of r-PCI Over Time in the Overall amp Key Subgroups

Feldman et al Circulation 20131272295

All Patients

Pts with Stable angina NSTE ACS STEMI

Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

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tr

20

08

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tr

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08

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09

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tr

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09

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tr

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11

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12

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18

16

14

12

10

8

6

4

2

161

R

ad

ial

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07

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08

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tr

20

08

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tr

20

09

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10

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20

10

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20

11

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20

11

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12

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20

12

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tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

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07

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10

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11

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UANSTEMI STEMI Stable Angina 2

0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

bull All antithrombotic agents (except fondaparinux bivalirudin) are associated with increased bleeding risk

bull Aspirin and heparin reduce death MI at 30 days in NSTE-ACS

Choice of arterial access site and outcomes in patients with acute coronary

siacutendromes managed with an early invasive strategy the ACUITY trial Hamon M Rasmussen LH Manoukian SV Cequier A Lincoff MA Rupprecht HJ Gersh BJ Mann T Bertrand ME Mehran R Stone GW

AIMS The purpose of this study was to evaluate the impact of arterial access site on bleeding and ischaemic outcomes overall and by

treatment strategy in patients with acute coronary syndromes (ACS)

METHODS AND RESULTS In the ACUITY trial 13819 patients with moderate and high-risk ACS were randomised to either heparin

(unfractionated or enoxaparin) plus a glycoprotein IIbIIIa inhibitor (GPI) bivalirudin plus a GPI or bivalirudin alone

Per operator choice femoral access was utilised in 11989 patients (938) and radial Access in 798 patients (62) There was no significant

difference in composite ischaemia between the radial and femoral approaches at 30 days (81 vs 75 p=018) or 1 year (147 vs

155 p=077)although fewer major bleeding complications occurred with the use of radial access (30vs48 p=003) Use of

bivalirudin monotherapy was associated with significantly less 30-day major bleeding than heparin plus GPI after femoral access

(30 vs 58 plt00001) but not with radial access (42 vs 22 P=019)

Major or minor organ bleeding was reduced with bivalirudin monotherapy compared to heparin plus GPI to a similar extent with both

femoral (41 vs 74 Plt00001) and radial (49 vs 72 P=026) access

EuroIntervention 2009 May5(1)115-20

CONCLUSIONS

Transradial compared to femoral arterial access is associated with similar rates of composite ischaemia

anwith fewer major bleeding complications in patients with ACS managed invasively

Bivalirudin monotherapy compared to heparin plus GPIs significantly reduces

access site related major bleeding complications with femoral

but not radial artery access though non-access site related bleeding is reduced by

bivalirudin monotherapy in all patients

0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)

CURE=Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (study) OASIS=Organization to Assess

Strategies for Ischemic Syndromes (study)

Reproduced with permission from Eikelboom JW et al Circulation 2006114774-782

Major Bleeding During First 30 Days Is Associated With Mortality Meta-analysis of 34146

ACS patients from the randomized OASIS OASIS-2 and CURE trials assessed the

association between bleeding within the first 30 days and death

Without major bleeding

With major bleeding

Days

Mo

rtality

(

)

Days from randomization

0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20

Major bleed only (without MI) (n=551)

Both MI and major bleed (n=94)

No MI or major bleed (n=12557)

MI only (without major bleed) (n=611)

Data on file The Medicines Company Parsippany NJ

289

125

86

34

Univariate analysis of 13819 patients from ACUITY

Impact of Non-CABG Major Bleeding and

MI at 30 Days on 1-Year Mortality

Radial Access 798 pts 62

Am Heart J 2009 Jan157(1)164-9 Epub 2008 Nov 6


Hypothetical mechanisms linking bleeding and mortality

Steg P G et al Eur Heart J 2011321854-

1864

Existing bleeding scores

bull TIMI Laboratory-based (hemoglobin hematocrit decrease)

bull GUSTO Clinical (severity)-based

bull GRACE Simplified laboratory and clinical

bull CURE Major minor (combined clin + lab)

bull ACUITY Major (intracranial-ocular access-site retroperit) lab

bull REPLACE-2 bull ISAR-REACT 3 bull PLATO bull STEEPLE bull CURRENT-OASIS

Thrombolysis conservative

PCI-based

BARC (Bleeding Academic Research Consortium) definitions

Mehran et al Circulation 20111232736-2747

bull Type 0 no evidence of bleeding bull Type 1 bleeding that is not actionable without

need for hospitalization or treatment (eg bruising hematoma nosebleeds etc)

bull Type 2 any clinically overt sign of hemorrhage that is actionable but does not meet criteria for type 3 4 or 5 Must meet at least 1 of following criteria ndash Requires intervention ndash Leads to hospitalization MANEJO MEDICO ndash Prompts evaluation



bull Type 3 clinical laboratory andor imaging evidence of bleeding with healthcare provider responses ndash BARC type 3a

bull any transfusion with overt bleeding bull overt bleeding plus hemoglobin drop ge3 to lt5 gdL

ndash BARC type 3b bull overt bleeding plus hemoglobin drop gt5 gdL bull Cardiac tamponade bull Bleeding requiring surgical intervention for control (excluding dentalnasalskinhemorrhoid) bull Bleeding requiring intravenous vasoactive drugs

ndash BARC type 3c bull Intracranial hemorrhage subcategories confirmed by autopsy

imaging or lumbar puncture bull Intraocular bleed compromising vision

BARC Bleeding Academic Research Consortium) definitions


bull Type 4 Coronary Artery Bypass Graftndashrelated bleeding ndash Perioperative intracranial bleeding within 48 hours ndash Reoperation after closure of sternotomy for the purpose of controlling bleeding ndash Transfusion of ge5 U whole blood or packed red blood cells within a 48-hour period ndash Chest tube output 2 L within a 24-hour period

bull Type 5 ndash fatal bleeding bull Probable fatal bleeding (type 5a)

ndash bleeding that is clinically suspicious as the cause of death but the bleeding is not directly observed and there is no autopsy or confirmatory imaging

bull Definite fatal bleeding (type 5b) ndash bleeding that is directly observed (by either clinical specimen [blood

emesis stool etc] or imaging) or confirmed on autopsy

26 VCD

11

NSTEACS or STEMI with invasive management Aspirin+P2Y12 blocker

Trans-Femoral Access

Trans-Radial Access

To demonstrate that trans-radial intervention as

compared to femoral access site is associated to lower

rate of the composite endpoint of Death MI or Stroke

within the first 30 days

1deg co-Primary Objective

6 vs 42 βlt10 α 25 8200 patients

Adaptive study Design sample size (SS) will be increased

by the cross-over rate at 70 of planned SS

MATRIX Access site NCT01433627

MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404

Cumulative enrollment by month

8404

8404

8404 patients with ACS undergoing coronary angiography plusmn PCI from 11th Oct 2011 to 7th Nov 2014

Operator Eligibility Criteria Interventional cardiologist expertise in TRI and TFI including at least 75 transradial coronary interventions and at least 50 of interventions performed via radial route in the year preceding site initiation

Complete follow-up to 30 days available in 4183 (997) of radial and 4191 (99middot6) of femoral cohorts

Am Heart J 2014 Dec168(6)838-45e6

Cross Over and Procedural Success Rates

941 of radial and 974 of femoral cohorts received respective treatment as allocated

In 58 of radial and 23 of TF cohort the allocated access was attempted but failed

In 3 (01) in the radial and 13 (03) patients in the femoral groups the allocated access was not attempted

P=077 Plt0001

TIMI lt3 andor final stenosis gt30

88

103

15 significant reduction at nominal 5 alpha

which is however NOT significant at the pre-specificed

alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM

Fatal and ST EPs All-Cause Cardiac non-CV mortality type of stent thrombosis

RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066

Mortality Stent Thrombosis

NNTB 167

Bleeding endpoints BARC TIMI GUSTO access vs non-access related

14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068

Rardial Better Femoral Better 1

HAZARD RATIO (95 CI)

P-VALUES

Superiority Interaction

089 Intermediate (548-991)

075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)

Intermediate (654-790)

Centrersquos

Proportion of

radial PCI

Low (149-644)

NSTE-ACS (tpndash) ACS type

STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062

NACE Subgroup Analysis

High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064

Radial Better Femoral Better 1


P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)

NSTE-ACS (tpndash) ACS

type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012

Intermediate (654-790) Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025

Updated Meta-analysis 19328 ACS patients being randomly allocated to radial or femoral access

Rardial Better Femoral Better 1 4 025 050 2

Pre-Rival RIVAL Post-RIVAL MATRI

X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined

SUBGROUP Risk Ratio (95CI) P Value

Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)

Summary bull Among patients with an ACS with or without ST-segment

elevation who underwent invasive management the use

of radial access for coronary angiography plusmn PCI reduced

the rate of net adverse clinical events with a number

needed to treat for benefit of 53

ndash Differences between groups were driven by reductions in BARC

major bleeding unrelated to CABG and all-cause mortality with

radial access

bull Our results in conjunction with the updated meta-

analysis suggest that radial approach should

become the default access for patients with

ACS undergoing invasive management

Radial Acces 61000 menos Muertes


LA VIA TRANSRADIAL DEBERIA SER EL ACCESO DE ELECCION PARA TODO PACIENTE CONSIN SCA TRATADOS CON INTERVENCIONISMO PERCUTANEO

GRACIAS POR SU ATENCION

MACE

Mortality

No interaction between access and anticoagulant use in a post- hoc analysis of the subgroup of 7213 patients randomized to bivalirudin or unfractionated heparin for the two co-primary outcomes all-cause mortality or BARC 3 or 5 bleeding

Relevance of bleeding as a clinical endpoint

bull Availability of potent antithrombotic therapy including ndash ASA ndash P2Y12 inhibitors (clopidogrel prasugrel ticagrelor) ndash heparin ndash GP IIbIIIa inhibitors ndash direct thrombin inhibitors

bull has led to a reduction in ischemic events bull but is associated with an increased risk of

bleeding bull the increase in bleeding is associated with worse

clinical outcome

Rationale for a new bleeding definition

bull Increased importance of bleeding as prognostic factor

bull Need for assessment of bleeding in RCTs and registries

bull Lack of comparability bull Need for standardized definitions to avoid

erroneous conclusions

ndash regarding safety of a given agent ndash regarding superiority of one agent over another

Open questions regarding BARC

bull Why 48-hour window for CABG-related bleeding

bull Why type 1 bdquonot actionableldquo when patient may bdquotake actionldquo such as discontinuing medication (with potentially serious consequences such as ST)

bull Why consider intraocular bleed equivalent to intracranial bleed for BARC 3c

bull Type 1 bleed subject to misinterpretation by the patient

Hicks et al (editorial) Circulation 20111232664

Conclusion

bull BARC is a new objective hierarchically graded classification of bleeding

(Mehran Circulation [June 14] 20111232736)

bull BARC is based on consensus rather than data-driven

bull Prospective validation is warranted ndash across the spectrum of IHD

ndash across management strategies (conservative invasive)

ndash in the context of all invasive procedures (PCI CABG endovascular TAVI)

Conclusion (2)

bull Final validation of BARC and proof of its utility depend on

ndash its use by all future RCTs as common safety endpoint

ndash unanimous assessment procedure (questionnaires)

bull More important than using one or the other bleeding risk score is the agreement and commitment among clinical trialists to use the same score for comparability of data



October 30 1958





Figure 1

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N 1455






0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177



p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

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tr

20

08

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tr

20

08

- Q

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20

09

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tr

20

09

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20

10

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20

10

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20

11

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20

11

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tr

20

12

- Q

tr

20

12

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tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

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20

10

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20

11

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20

11

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20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)







Figure 1

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Figure 6

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N 1455






0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177



p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)







Figure 6

copy 2

014 E

uro

pa D

igital amp

Publis

hin

g A

ll rig

hts

reserv

ed




N 1455






0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177



p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)






N 1455






0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177



p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)










0

20

40

60

80

100

393 874 96

n꞊280 n꞊657 n꞊1177



p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)






p lt 001

diacuteas

AF 057

AR 068

CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





CONCLUSIONES







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)







All Patients


Overall Radial PCI

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

20

18

16

14

12

10

8

6

4

2

161

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr

Male Female 20

18

16

14

12

10

8

6

4

2

R

ad

ial

20

07

- Q

tr

20

07

- Q

tr

20

08

- Q

tr

20

08

- Q

tr

20

09

- Q

tr

20

09

- Q

tr

20

10

- Q

tr

20

10

- Q

tr

20

11

- Q

tr

20

11

- Q

tr

20

12

- Q

tr

20

12

- Q

tr


0

1

8

1

6

1

4

1

2

1

0

8

6

4

2

IAM

















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





















CONCLUSIONS







0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





0 5 10 15 20 25 30

0

20

40

60

80

100

120

140

Mo

rta

lity

(

)








With major bleeding

Days

Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





Mo

rtality

(

)


0 30 60 90 120 150 180 210 240 270 300 330 360 390

0

5

15

30

10

25

20






289

125

86

34









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)









1864









PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)













PCI-based




















26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)
























26 VCD

11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





11



Trans-Radial Access










MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





MATRIX Access

39 93 132 200 276 380 490 685 857 1002 1190

1400 1684 1972 2248

2584 2926

3256 3560

3875 4144

4452 4726

5000 5322

5655 5896 6184

6458 6742 6982 7235 7444 7638 7844 8073

8404


8404

8404




Am Heart J 2014 Dec168(6)838-45e6





P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)









P=077 Plt0001


88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





88

103



alpha of 25

Primary EP MACE

Femoral

Radial

Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





Rate Ratio 083 95 CI 073 to 096 p=00092

117

98

NNTB 53 Femoral

Radial

Primary EP NACE

Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)





Mortalidad Total

IAM


RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)






RR072

(053-099)

P=0045

RR 075

(054-104)

P=008 1

13

06

1

0

02

04

06

08

1

12

14

Radial Femoral

P=069

P=066


NNTB 167


14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)






14

25

P=0013

RR 067 049-092

P=00004

RR 037 021-066

BARC 3 or 5

P=00098

RR 064 045-090

P=008

RR 072 050-104 P=020

RR 078 053-114

Major

or minor

moderate

or severe

P=082

P=068



P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)







P-VALUES



075 (060-094)

104 (082-132) 076 0011

Centrersquos annual

volume of PCI

Low (247-544)


Centrersquos

Proportion of

radial PCI

Low (149-644)


STEMI

lt75 Age

ge75 023 088 (070-109)

082 (068-097) 0023 062


High (1000-1950)

High (800-980)

NSTE-ACS (tp+)

Men Sex

Women

lt25 BMI

ge25

No

Ticagrelor or

prasugrel Yes

No Diabetes

Yes

lt60 GFR

ge60

No

History of

PVD Yes

2 025 050

075 (058-097) 0025

00048

101 (079-129)

095 (075 -122) 071

095

064 (051-080) lt0001

044

086 (068-108)

058 (033-103) 0059

019

085 (071-102) 007

0012 072 (056-093)

089 (076-105) 016 018

009 086 (073-102)

079 (063-099) 0038 053

007 083 (068-102)

084 (070-101) 006 094

045 091 (071-117)

080 (068-094) 008 043

001 078 (065-094)

086 (070-107) 018 051

060 091 (064-130)

083 (071-096) 0012 064



P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)







P-VALUES



Centrersquos

Proportion

of radial PCI

Low (149-644)


type

STEMI

Subgroup Analysis

High (800-980)

NSTE-ACS (tp+)

2

00157

128 (071-232)

069 (040 -119) 018

041

048 (028-081) 0006

010

087 (059-129) 049

049 (028-087) 0012


Proportion

of radial PCI

Low (149-644)


type

STEMI

High (800-980)

NSTE-ACS (tp+)

020

090 (054-150)

057 (031 -103) 006

068

056 (032-097) 0035

054

062 (041-094)

166 (028-100) 058

0022

070 (042-117) 017

Mortality

Bleeding

4 050 025

1 2 050 025




X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)








X Combined

Non-CABG

major bleeds

Death

myocardial

infarction or

stroke

Death

Myocardial

Infarction

Stroke


X Combined


X Combined


X Combined


X Combined


Heterogenity

P Value I2

073 (043-123) 039 (023-067)

058 (046-072)

041 (022-076)

lt00001 0 05

1

067 (048-093) 086 (076-098) 086 (077-095)

098 (076-127)

00051 0 09

7

058 (039-087) 073 (053-099) 072 (060-088) 00011 0 10

0

085 (039-190) 091 (078-106) 091 (079-104)

092 (065-131)

01

6 0 08

8

068 (049-092)

082 (052-129)

077 (046-128) 086 (058-129)

073 (012-447)

140 (045-440) 100 (050-200) 105 (069-160)

143 (072-283)

08

0 0 07

5

026 (006-123)








radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)












radial access









MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)








MACE

Mortality






clinical outcome













Conclusion







Conclusion (2)










clinical outcome













Conclusion







Conclusion (2)

















Conclusion







Conclusion (2)





Conclusion (2)





acceso en el stemi radial vs femoral · 2016-06-10 · acceso en el stemi radial vs femoral dr...

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