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. 2024 Mar 14;11:1349480. doi: 10.3389/fcvm.2024.1349480

Table 2.

Clinical trials comparing radial versus femoral arterial access in acute coronary syndrome.

Study name RIVAL (44) RIFLE-STEACS (35) RIVAL-STEMI (45) MATRIX (46) SAFARI-PCI (48)
Study Design Multicenter, 32 countries.
1:1 randomization;
Open label		 Multicenter, European, 1:1 randomization;
Open label.
4 high volume radial centers		 Multicenter, 32 countries, 1:1 randomized, open label. Multicenter, European centers; 1:1 randomization; 0pen Label Multicenter, 5 PCI centers in Canada.
Randomized, open label.
Population 7,021 patients with ACS 1,001 patients with STEMI 1,958 patients with STEMI 8,404 patients with ACS 2,292 STEMI patients
Study arms Radial vs. Femoral Radial vs. Femoral Radial vs. Femoral Radial vs. Femoral Radial vs. Femoral
Outcomes
  • -

    Composite of death, MI, stroke, or bleeding: 3.7% vs. 4%. P = 0.50

  • -

    Vascular complications including pseudoaneurysm, hematoma, fistula, ischemic limb: 1.4% vs. 3.7%. P < 0.0001
  • -

    Composite of CV death, recurrent MI, CVA, TLR or bleeding: 13.6% Vs 21%; p = 0.003
  • -

    Composite of death, MI, CVA or bleeding: 3.1% vs. 5.2%. P = 0.026

  • -

    Vascular complications: 1.3% vs. 3.4%. P = 0.002
  • -

    Co-primary composite endpoints of

  • 1.

    Death, MI or stroke: 8.8% TRA vs. 10.3% TFA; p = 0.0307.

  • 1.

    Death, MI, stroke, or BARC non-CABG major bleeding: 9.8% TRA vs. 11.7% TFA; p = 0.0092.
  • -

    30-day all-cause mortality: 1.5% vs. 1.3%. P = 0.69

ACS, acute coronary syndrome; BARC, bleeding academic research consortium; CABG, coronary artery bypass graft surgery; CVA, cerebrovascular access; MATRIX, minimizing adverse haemorrhagic events by transradial access site and systemic implementation of AngioX; MI, myocardial infarction; RIFLE-STEACS, Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome; RIVAL, radial versus femoral access for coronary angiography and intervention in patients with acute coronary ssyndromes; SAFARI STEMI, safety and efficacy of femoral access vs radial access in ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction; TFA, transfemoral access; TRA, transradial arterial access; TLR, target lesion revascularization.