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VIDEO: Data support switching to transradial PCI access


 

EXPERT ANALYSIS FROM ACC 15

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SAN DIEGO – Cardiologists should switch from transfemoral to transradial access in acute coronary syndrome patients undergoing percutaneous coronary intervention, given the reduced mortality rates associated with the transradial approach in the MATRIX study and other studies, Dr. Cindy L. Grines said at the annual meeting of the American College of Cardiology.

Because U.S. interventionalists are “under the clock” when treating patients with ST-elevation myocardial infarction, “many physicians have been unwilling to risk having a difficult transradial case that would take too much time,” explained Dr. Grines, an interventional cardiologist at the Detroit Medical Center.

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For that and other reasons, American interventionalists have been “slow adopters” of the transradial approach, currently using it for about 20% of PCIs, compared with a worldwide rate of about 70%.

It may take instituting incentives to get U.S. cardiologists to change their practice, Dr. Grines suggested in an interview. That could involve increased reimbursement for PCIs done transradially, an increased allowance on acceptable door-to-balloon times for STEMI patients treated transradially, or imposition of new standards for quality assurance that mandate use of transradial in a certain percentage of PCI cases, she said.

The MATRIX study included a second, independent, prespecified analysis that compared outcomes in patients randomized to treatment with two different antithrombin drugs, either bivalirudin (Angiomax) or unfractionated heparin.

That part of the study showed that while treatment with either of the two drugs resulted in no statistically significant difference in the study’s two primary endpoints, treatment with bivalirudin led to statistically significant reductions in all-cause death and cardiovascular death, as well as in major bleeding events, compared with patients treated with unfractionated heparin (Lancet 2015 [doi:10.1016/S0140-6736(15)60292-6]).

Although bivalirudin has generally been the more commonly used antithrombin drug in this clinical setting by U.S. interventionalists in recent years, results reported last year from the HEAT-PCI trial (Lancet 2014;384:1849-58) that showed better outcomes with unfractionated heparin have led to reduced use of bivalirudin, Dr. Grines said.

The new results from MATRIX coupled with results from other trials that compared those drugs can make clinicians “more confident about the benefit of bivalirudin,” she said.

Dr. Grines has been a consultant to and received honoraria from the Medicines Company, which markets Angiomax, and from Abbott Vascular, Merck, and the Volcano Group.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

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