Association between the Use of Fondaparinux Plus Radial Access and Clinical Outcomes in Patients with Non-ST Elevation Acute Coronary Syndrome.

BACKGROUND: Both fondaparinux and radial access have been associated with lower rates of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). OBJECTIVE: To evaluate the association between the use of fondaparinux plus radial access and clinical outcomes. METHODS: In this study, 956 patients admitted with ACS and treated with an invasive strategy were analyzed. The primary outcome - a composite of major bleeding (according to OASIS-5 criteria) and MACE - was compared across groups defined by anticoagulation regimen (fondaparinux or enoxaparin) plus arterial access site (femoral vs. radial). A p-value < 0.05 was considered statistically significant. RESULTS: The mean age of the study population was 65 ± 12.4 years, and 49.5% presented with non-ST segment elevation myocardial infarction (NSTEMI). Fondaparinux and radial access were used concurrently in 366 patients. The primary endpoint occurred in 78 patients (8.1%): MACE in 50 (5.2%) and major bleeding in 32 (3.3%). The event rate was lowest in the fondaparinux plus radial access group (3.3%), compared with enoxaparin plus radial access (9.8%), fondaparinux plus femoral access (8.6%), and enoxaparin plus femoral access (14.4%) (p < 0.001). Multivariable analysis showed that the use of fondaparinux was associated with a 43% reduction in the primary outcome (OR, 0.57; 95% CI, 0.34-0.96; p < 0.05), and radial access was independently associated with a 54% reduction (OR, 0.46; 95% CI, 0.26-0.83; p = 0.01). CONCLUSION: The combination of fondaparinux and radial access was associated with the lowest rates of MACE and major bleeding, compared to either strategy alone.