Problem PCI for ACS
Format Randomised, parallel group, multicentre trial
Treatment Radial access
Control Femoral access
Population 7021 patients
Inclusion criteria UA/NSTEMI and STEMI
At least 50 cases of experience of radial access by operator
Suitable for both radial and femoral access
Intact dual circulation of hand required
Interventionalist experienced with both (minimum 50 radial procedures in last year)
Exclusion criteria Age < 18
Active bleeding or significant increased risk of bleeding (severe hepatic insufficiency, current peptic ulceration, proliferative diabetic retinopathy)
Uncontrolled hypertension
Cardiogenic shock
Prior CABG surgery with use of <1 internal mammary artery
Documented severe peripheral vascular disease precluding a femoral approach
Previously entered in the study
Investigational treatment (drug or device) within the previous 30 days
Medical, geographic, or social factors making study participation impractical or inability to provide written informed consent and to understand the full meaning of the informed consent
Follow-up 30 days
Primary endpoint Composite or death, MI, stroke or non-CABG-related Major Bleeding at 30 days
Secondary endpoint(s) Death, MI, Stroke
Non-CABG Major Bleeding
Separate endpoints

-Major Bleeding
--2 or more units blood transfused
--Hypotension requiring inotropes
--Leading to Hb drop of 5 g/dL or more
--Requiring surgery
--ICH or intraoccular bleeding leading to significant vision loss
-Major vascular site complication
--Large haematoma
--Pseudoaneurysm requiring closure
--AV fistula
--Other vascular surgery needed at site
Details Half of patients were from a sub-study of CURRENT/OASIS 7
Brief summary: Radial access gives similar results and fewer vascular complications
PAPER: Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.
Date 23 Apr 2011
Journal Lancet. 2011 Apr 23;377(9775):1409-20.
Information Radial vs. femoral access for ACS
-No difference in composite of death, MI, stroke or non-CABG major bleeding
-Possible adantage in
--Higher volume centres
-Fewer vascular complications for radial access