PMID- 32151464 OWN - NLM STAT- MEDLINE DCOM- 20211112 LR - 20220531 IS - 1885-5857 (Electronic) IS - 1885-5857 (Linking) VI - 73 IP - 11 DP - 2020 Nov TI - Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest. PG - 893-901 LID - S1885-5857(20)30034-7 [pii] LID - 10.1016/j.rec.2020.01.005 [doi] AB - INTRODUCTION AND OBJECTIVES: Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited. We assessed outcomes of transradial vs transfemoral access and bivalirudin vs unfractionated heparin (UFH) in VP with acute coronary syndrome undergoing invasive management. METHODS: The MATRIX trial randomized 8404 patients to radial or femoral access and 7213 patients to bivalirudin or UFH. Among them, 934 (11.1%) were deemed VP due to advanced Killip class (n = 808), cardiac arrest (n = 168), or both (n = 42). The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACE: death, myocardial infarction, or stroke) and net adverse clinical events (NACE: MACE or major bleeding). RESULTS: MACE and NACE were similarly reduced with radial vs femoral access in VP and non-VP. Transradial access was also associated with consistent relative benefits in all-cause and cardiovascular mortality or Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding with greater absolute benefits in VP. The effects of bivalirudin vs UFH on MACE and NACE were consistent in VP and non-VP. Bivalirudin was associated with lower all-cause and cardiovascular mortality in VP but not in non-VP, with borderline interaction testing. Bivalirudin reduced bleeding in both VP and non-VP with a larger absolute benefit in VP. CONCLUSIONS: In acute coronary syndrome patients undergoing invasive management, the effects of randomized treatments were consistent in VP and non-VP, but absolute risk reduction with radial access and bivalirudin were greater in VP, with a 5- to 10-fold lower number needed to treat for benefits. Trial registry number: NCT01433627. CI - Copyright (c) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved. FAU - Gargiulo, Giuseppe AU - Gargiulo G AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. FAU - Valgimigli, Marco AU - Valgimigli M AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: marco.valgimigli@insel.ch. FAU - Sunnaker, Mikael AU - Sunnaker M AD - Clinical Trials Unit (CTU) Bern, University of Bern, Bern, Switzerland. FAU - Vranckx, Pascal AU - Vranckx P AD - Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium & Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. FAU - Frigoli, Enrico AU - Frigoli E AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. FAU - Leonardi, Sergio AU - Leonardi S AD - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. FAU - Spirito, Alessandro AU - Spirito A AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. FAU - Gragnano, Felice AU - Gragnano F AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland; Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Manavifar, Negar AU - Manavifar N AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. FAU - Galea, Roberto AU - Galea R AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. FAU - De Caterina, Alberto R AU - De Caterina AR AD - Ospedale del Cuore - Massa, Fondazione Toscana "G. Monasterio", Pisa, Italy. FAU - Calabro, Paolo AU - Calabro P AD - Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Esposito, Giovanni AU - Esposito G AD - Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. FAU - Windecker, Stephan AU - Windecker S AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. FAU - Hunziker, Lukas AU - Hunziker L AD - Department of Cardiology, Bern University Hospital, Bern, Switzerland. LA - eng LA - spa SI - ClinicalTrials.gov/NCT01433627 PT - Journal Article PT - Randomized Controlled Trial DEP - 20200306 PL - Spain TA - Rev Esp Cardiol (Engl Ed) JT - Revista espanola de cardiologia (English ed.) JID - 101587954 RN - 0 (Anticoagulants) RN - 0 (Antithrombins) RN - 0 (Hirudins) RN - 0 (Peptide Fragments) RN - 0 (Recombinant Proteins) RN - 9005-49-6 (Heparin) SB - IM MH - *Acute Coronary Syndrome/complications/drug therapy MH - Anticoagulants/therapeutic use MH - Antithrombins MH - Heparin MH - Hirudins MH - Humans MH - *Out-of-Hospital Cardiac Arrest/drug therapy MH - Peptide Fragments MH - *Percutaneous Coronary Intervention MH - Recombinant Proteins MH - Treatment Outcome OTO - NOTNLM OT - Acceso radial OT - Acute coronary syndrome OT - Acute heart failure OT - Bivalirudin OT - Bivalirudina OT - Cardiac arrest OT - Insuficiencia cardiaca aguda OT - Paciente vulnerable OT - Parada cardiaca OT - Radial access OT - Sindrome coronario agudo OT - Vulnerable patients EDAT- 2020/03/11 06:00 MHDA- 2021/11/16 06:00 CRDT- 2020/03/11 06:00 PHST- 2019/07/10 00:00 [received] PHST- 2020/01/13 00:00 [accepted] PHST- 2020/03/11 06:00 [pubmed] PHST- 2021/11/16 06:00 [medline] PHST- 2020/03/11 06:00 [entrez] AID - S1885-5857(20)30034-7 [pii] AID - 10.1016/j.rec.2020.01.005 [doi] PST - ppublish SO - Rev Esp Cardiol (Engl Ed). 2020 Nov;73(11):893-901. doi: 10.1016/j.rec.2020.01.005. Epub 2020 Mar 6.