This study compared radial and femoral access approaches in percutaneous coronary intervention (PCI) among patients receiving bivalirudin. No significant differences in ischemic events or major bleeding complications were found at 30 days between the two approaches; however, radial access was associated with reduced minor and access site bleeding. The findings suggest that while both access methods are viable, radial access may offer safety advantages in terms of bleeding risk.

1. Radial versus Femoral access
approaches in percutaneous
coronary intervention of patients
receiving bivalirudin.
Martial Hamon, Christopher Nienaber , Stefano Galli, Janusz Lipiecki,
Kurt Huber, Britta Goldmann, Dietrich Gulba, Debra Bernstein,
Efthymios Deliargyris, on behalf of the EUROVISION Investigators.
1

2. Background
● Radial access has been associated with reductions in
bleeding complications during PCI, primarily due to
reductions in access site bleeding.
● Bivalirudin monotherapy has been shown to reduce both
access and non-access site bleeding.
● The impact of radial versus femoral access choice in
patients undergoing PCI with bivalirudin monotherapy is
largely unknown.
2

3. Methods
● Eurovision was a prospective observational study conducted in 58
European sites to track utilization patterns of bivalirudin in PCI.
● In hospital and 30-day outcomes in 1933 consecutive patients were
compared according to access site choice (1353 Femoral versus 580
Radial).
● Outcomes were collected for ischemic events (death, MI, stroke and
urgent revascularization), and bleeding in hospital and at 30 days between
the two groups.
● Major bleeding, ACUITY definition (any one of the following): Intracranial,
retroperitoneal, or intraocular bleeding, access site hemorrhage requiring
radiological or surgical intervention, ≥5 centimeter(cm) diameter
hematoma at puncture site, decrease in hemoglobin (Hgb) concentration
of ≥4 g/dl without an overt source of bleeding, decrease Hgb concentration
of ≥3 g/dl with an overt source of bleeding, re-operation for bleeding, any
blood product transfusion
● Minor bleeding was any bleeding not included in the definition of major
bleeding
● Multivariate analysis was conducted on the overall population to determine
predictors of ischemic events, and major and minor bleeding
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4. Access route by country and diagnosis
Bivalirudin Bivalirudin
Country Femoral Radial
(N=1353) (N=580)
France 14.6% 62.9%
Italy 16.0% 28.3%
Austria 21.4% 0.7%
United Kingdom 4.4% 3.6%
Germany 43.5% 4.5%
Diagnosis
Stable Angina 29.3% 15.5%
Unstable Angina 14.7% 18.1%
NSTEMI 20.8% 33.8%
STEMI 35.1% 32.6%
4

5. Baseline characteristics
Bivalirudin Bivalirudin p-value
Femoral Radial
(n=1353) (n=580)
Age (yrs), mean ± SD 65.7 ± 11.6 65.4 ± 12.2 NS
Age >65 yr 56.8% 53.6% NS
Female 23.7% 24.3% NS
Weight (kg) mean ± SD 80.0 ± 14.9 79.3 ± 14.9 NS
Prior MI 26.5% 19.8% 0.003
Dyslipidemia 63.3% 54.1% <0.0001
Prior PCI 35.3% 24.7% <0.0001
Hypertension 72.7% 59.5% <0.0001
Previous CABG 8.2% 5.0% 0.0436
Congestive Heart Failure 8.0% 3.4% <0.0001
Current Smoker 29.2% 28.8% <0.0001
Family history of PVD 21.5% 16.4% <0.0001
Diabetes 24.4% 20.9% NS
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6. 30 day Ischemic Outcomes
(unadjusted)
• There were no differences noted in ischemic events at 30 days
between the two groups
Femoral Radial P-value
(n=1353) (n=580)
Death/ MI/ Stroke/ Revasc 3.2% 2.2% 0.2605
Death/MI/ Revasc/ Stroke/ 4.7% 3.3% 0.1483
Major Bleed
Death 1.1% 0.9% 0.6234
MI 1.6% 0.2% 0.0088
Unplanned revasc 0.7% 1.4% 0.1233
Stroke 0.3% 0 0.1899
Stent thrombosis 0.2 0.5 0.2844
Acute 0.1 0.2 0.5370
Sub-acute 0.1 0.3 0.3824
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7. Bleeding Outcomes (unadjusted)
Femoral Radial P-value
(n=1353) (n=580)
Major Bleeding 1.7% 1.2% 0.4216
Minor Bleeding 4.8% 1.9% 0.0026
Thrombocytopenia 0 0
Any bleeding 8.0% 4.5% 0.0055
Access Site Bleed 3.6% 1.0% 0.0017
Non-Access Site Bleed 1.6% 0.9 0.1897
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8. Independent predictors of ischemic
events and major bleeding
Odds Ratio P-
(95% CI) value
Ischemic event s (D/
MI/Urgent revasc/
Stroke
Congestive heart
2.37 [1.22-4.61] 0.011
failure
Major bleeding
(ACUITY)
Renal impairment 3.99 [1.93-8.26] <0.001
0 1 2 3 4 5 6 7 8 9

9. Independent predictors of minor
bleeding
Odds Ratio P-
(95% CI) value
Age ≥ 65 1.96 [1.15 - 3.33] 0.013
Hypertension 2.86 [1.40 - 5.87] 0.004
Prior PCI 0.58 [0.34 - 0.98] 0.044
Radial access 0.40 [0.21 - 0.79] 0.007
0 1 2 3 4 5 6

10. Conclusions
● In the context of bivalirudin monotherapy during PCI,
both ischemic and major bleeding complication rates
at 30 days were similar irrespective of a femoral
versus radial access site choice.
● The choice of radial access, however, was associated
with lower rates of both minor and access site
bleeding.
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