TY - JOUR
T1 - Prediction of radial crossover in acute coronary syndromes
T2 - Derivation and validation of the MATRIX score
AU - Gragnano, Felice
AU - Jolly, Sanjit S.
AU - Mehta, Shamir
AU - Branca, Mattia
AU - van Klaveren, David
AU - Frigoli, Enrico
AU - Gargiulo, Giuseppe
AU - Leonardi, Sergio
AU - Vranckx, Pascal
AU - Di Maio, Dario
AU - Monda, Emanuele
AU - Fimiani, Luigi
AU - Fioretti, Vincenzo
AU - Chianese, Salvatore
AU - Andò, Giuseppe
AU - Esposito, Giovanni
AU - Sangiorgi, Giuseppe Massimo
AU - Biondi-Zoccai, Giuseppe
AU - Heg, Dik
AU - Calabrò, Paolo
AU - Windecker, Stephan
AU - Romagnoli, Enrico
AU - Valgimigli, Marco
N1 - Funding:
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.
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85117788864&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-21-00441
DO - 10.4244/EIJ-D-21-00441
M3 - Article
C2 - 34374343
AN - SCOPUS:85117788864
SN - 1774-024X
VL - 17
SP - E971-E980
JO - EuroIntervention
JF - EuroIntervention
IS - 12
ER -