Prediction of radial crossover in acute coronary syndromes: Derivation and validation of the MATRIX score

Felice Gragnano, Sanjit S. Jolly, Shamir Mehta, Mattia Branca, David van Klaveren, Enrico Frigoli, Giuseppe Gargiulo, Sergio Leonardi, Pascal Vranckx, Dario Di Maio, Emanuele Monda, Luigi Fimiani, Vincenzo Fioretti, Salvatore Chianese, Giuseppe Andò, Giovanni Esposito, Giuseppe Massimo Sangiorgi, Giuseppe Biondi-Zoccai, Dik Heg, Paolo CalabròStephan Windecker, Enrico Romagnoli, Marco Valgimigli*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


Background: The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. Aims: We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. Methods: The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. Results: The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cutoff of ≥41 points was selected to identify patients at high risk of radial crossover. Conclusions: The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.

Original languageEnglish
Pages (from-to)E971-E980
Issue number12
Publication statusPublished - Dec 2021

Bibliographical note

The MATRIX trial was sponsored by the Società Italiana di
Cardiologia Invasiva (GISE, a non-profit organisation), which
received grant support from The Medicines Company and Terumo.
This substudy did not receive any direct or indirect funding.

Publisher Copyright: © Europa Digital & Publishing 2021.


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