Design and rationale of the radIal Vs. femorAL access for coronary intervention (RIVAL) trial: A randomized comparison of radial versus femoral access for coronary angiography or intervention in patients with acute coronary syndromes

ABSTRACT

Background Major bleeding in acute coronary syndromes (ACS) is associated with an increased risk of subsequentmortality and recurrent ischemic events. Observational data and small randomized trials suggest that radial instead of femoralaccess for coronary angiography/intervention results in fewer bleeding complications, with preserved and possibly improvedefficacy. Radial access versus femoral access has yet to be formally evaluated in a randomized trial adequately powered forthe comparison of clinically important outcomes.Objectives The aim of this study is to evaluate the efficacy and safety of radial versus femoral access for coronaryangiography/intervention in patients with ACS managed with an invasive strategy.Design This was a multicenter international randomized trial with blinded assessment of outcomes. 7021 patients withACS (with or without ST elevation) have been randomized to either radial or femoral access for coronary angiography/intervention. The primary outcome is the composite of death, myocardial infarction, stroke, or non–coronary artery bypassgraft-related major bleeding up to day 30. The key secondary outcomes are (1) death, myocardial infarction, or stroke up today 30 and (2) non–coronary artery bypass graft-related major bleeding up to day 30. Percutaneous coronary intervention(PCI) success rates will also be compared between the two access sites.Conclusions The RIVAL trial will help define the optimal access site for coronary angiography/intervention in patientswith ACS.