Felice Gragnano1,2, MD; Sanjit S. Jolly3, MD; Shamir R. Mehta3, MD; Mattia Branca4, PhD; David van Klaveren5, PhD; Enrico Frigoli4, MD; Giuseppe Gargiulo6, MD, PhD; Sergio Leonardi7, MD, MHS; Pascal Vranckx8,9, MD, PhD; Dario Di Maio2, MD; Emanuele Monda2, MD; Luigi Fimiani10, MD; Vincenzo Fioretti6, MD; Salvatore Chianese6, MD; Giuseppe Andò10, MD, PhD; Giovanni Esposito6, MD, PhD; Giuseppe Massimo Sangiorgi11, MD; Giuseppe Biondi-Zoccai12,13, MD, MStat; Dik Heg4, PhD; Paolo Calabrò2, MD, PhD; Stephan Windecker1, MD; Enrico Romagnoli14, MD, PhD; Marco Valgimigli1,15
1. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland; 2. Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy; 3. Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada; 4. Clinical Trials Unit, University of Bern, Bern, Switzerland; 5. Erasmus University Medical Center, Rotterdam, the Netherlands; 6. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; 7. University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy; 8. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; 9. Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium; 10. Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 11. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; 12. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; 13. Mediterranea Cardiocentro, Naples, Italy; 14. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 15. Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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 cut-off 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.
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