SCAI Statement on "The Rival Trial: A Randomized Comparison of Radial Versus Femoral Access for Coronary Angiography or Intervention in Patients with Acute Coronary Syndromes"

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The Society for Cardiovascular Angiography and Interventions (SCAI)

April 4, 2011 -- New Orleans -- Patients with acute coronary syndromes who undergo angiography or angioplasty and stent procedures have similar probability of survival whether their arteries are accessed radially (via the wrist) or femorally (via the groin, or upper leg); however, when patients are suffering from a major heart attack, there is significant survival benefit if the heart arteries are accessed radially. The results of the eagerly awaited RIVAL Trial were presented today at the American College of Cardiology (ACC) 60th Annual Scientific Sessions.

The RIVAL Trial is the first large North American randomized clinical trial comparing the two options for accessing the heart arteries. The findings are likely to impact practice in the United States because:

Radial access has now been shown to be a safe and effective technique in North American patients;
Heart attack patients had a significant survival benefit when they were treated transradially;
The data corroborate previous studies showing that radial access is preferred by patients.

In recent years, debate has centered around which major artery should be used to insert a catheter, a thin, flexible tube used in many minimally invasive tests and procedures to diagnose and treat blocked heart arteries. Although radial access has been used abroad for some time, it remains relatively unused in the United States.

Importantly, the RIVAL Trial results showed that physicians with greater experience using the radial technique had the best outcomes. This finding underscores the need to provide high-quality physician education and training in radial-access heart procedures, as currently only 4.5 percent of coronary procedures in the United States are performed transradially.

SCAI’s Transradial Working Group has developed a series of educational programs for interventional cardiologists to be trained in the use of radial access. The demand for these programs has been high, and SCAI plans to offer at least four programs nationwide in 2011.

Remarks From SCAI's Committee On Transradial Interventions:

"The data from the RIVAL trial are important because they add to the evidence showing that the technique that is more comfortable for patients is also safe and effective," said Kimberly A. Skelding, M.D., FSCAI, an interventional cardiologist at Geisinger Medical Center in Danville, Pa.

"These results should provide ample evidence for greater use of the radial option for many minimally invasive cardiovascular tests and procedures, especially in patients suffering from a heart attack."

Kimberly A. Skelding.
MD, FSCAI

Samir Pancholy,
MD, FSCAI

"Transradial access has been widely used and accepted in other countries, but has not yet been fully accepted in the U.S.," said Samir Pancholy, M.D., FSCAI, an interventional cardiologist at the Commonwealth Medical College in Scranton, Pa.

"The RIVAL Trial shows that our sickest patients will benefit the most if we invest in training physicians to perform the radial technique frequently and safely, hence making it available when patients need it the most."

Source: The Society for Cardiovascular Angiography and Interventions (SCAI)