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5. LatHyS global hybrid simulation of the BepiColombo second Venus flyby

Author

Aizawa, S., Persson, M., Menez, T., André, N., Modolo, R., Génot, V., Sanchez-Cano, B., Volwerk, M., Chaufray, J.-Y., Baskevitch, C., Heyner, D., Saito, Y., Harada, Y., Leblanc, F., Barthe, A., Penou, E., Fedorov, A., Sauvaud, J.-A., Yokota, S., Auster, U., Richter, I., Mieth, J., Horbury, T.S., Louarn, P., Owen, C.J., and Murakami, G.

Published
2022
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6. BepiColombo mission confirms stagnation region of Venus and reveals its large extent

Author

Persson, M., Aizawa, S., André, N., Barabash, S., Saito, Y., Harada, Y., Heyner, D., Orsini, S., Fedorov, A., Mazelle, C., Futaana, Y., Hadid, L. Z., Volwerk, M., Collinson, G., Sanchez-Cano, B., Barthe, A., Penou, E., Yokota, S., Génot, V., Sauvaud, J. A., Delcourt, D., Fraenz, M., Modolo, R., Milillo, A., Auster, H.-U., Richter, I., Mieth, J. Z. D., Louarn, P., Owen, C. J., Horbury, T. S., Asamura, K., Matsuda, S., Nilsson, H., Wieser, M., Alberti, T., Varsani, A., Mangano, V., Mura, A., Lichtenegger, H., Laky, G., Jeszenszky, H., Masunaga, K., Signoles, C., Rojo, M., and Murakami, G.

Published
2022
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7. Venusian ion escape under extreme conditions: A dynamic pressure and temperature simulation study.

Author

Katrougkalou, M. C., Persson, M., Aizawa, S., André, N., Modolo, R., Jariel, E., Kullen, A., and Karlsson, T.

Abstract

Context. We investigated the response of the Venusian atmospheric ion escape under the effect of interplanetary coronal mass ejections (ICMEs) using the Latmos Hybrid Simulation (LatHyS). Aims. In particular, we focused on the influence of extreme ICME dynamic pressures and temperatures, with the temperature being a parameter that has not been extensively studied in the past. Methods. Simulations were performed for two different dynamic pressures and three different temperatures. For the case of the dynamic pressure simulations, a density and a velocity enhancement event were studied separately. The H+ and O+ ion escape was then examined and compared for different escape channels. Results. In both dynamic pressure enhancement cases, we find that there is no clear dependence of the O+ ion escape on the dynamic pressure, which is consistent with observations. On the other hand, the temperature of the incoming solar wind positively influences the H+ and O+ ion escape. This is attributed in part to the enhanced gyroradius of the particles, which allows them to penetrate deeper into the planet's atmosphere. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Sunward Oxygen Ion Fluxes and the Magnetic Field Topology at Mars From Hybrid Simulations.

Author

Dubinin, E., Modolo, R., Leblanc, F., Pätzold, M., and Romanelli, N.

Subjects
*INTERPLANETARY magnetic fields, *MAGNETIC reconnection, *SOLAR magnetic fields, *MAGNETIC fields, *MAGNETIC ions, *MARTIAN atmosphere, *SOLAR wind
Abstract

It is commonly believed that because of the direct solar wind interaction with the Martian atmosphere/ionosphere, the planet could have lost a significant part of its atmosphere. Closed field lines of the crustal magnetic field can weaken a transport of the ionospheric ions to the tail. Reconnection of the interplanetary magnetic field lines draping around Mars and the crustal magnetic field can also lead to a presense of sunward fluxes of planetary ions that might affect the total ion loss. The LatHyS (LATMOS Hybrid Simulation) three‐dimensional multispecies hybrid model is used here to characterize sunward fluxes of O+ ions and the magnetic field topology at Mars. It is shown that although reconnection between the interplanetary magnetic field (IMF) and the crustal magnetic fields strongly modifies the field topology, then sunward ion fluxes are rather small and do not significantly change the total ion loss. Plain Language Summary: Although Mars has no a global intrinsic magnetic field and solar wind interacts directly with the planetary atmosphere/ionosphere, the existence of strong but localized crustal magnetic field modifies the field topology around Mars. As a result, the Martian magnetosphere contains elements of the intrinsic and the induced magnetospheres. Reconnection between the interplanetary magnetic field and the crustal magnetic field can generate the plasma flows toward the planet and decrease the ionospheric losses, which is very important for the evolution of the Mars atmosphere/ionosphere. We have performed the numerical simulations of these potential effects and shown that the sunward ion fluxes are significantly less than the losses induced by the solar wind impact on the Martian ionosphere. Key Points: Hybrid simulations show a drastic change of the field topology at altitudes less than ∼1,000 km due to crustal field sourcesAlthough the magnetic field topology is modified, the sunward fluxes do not essentially affect the total ion lossSunward fluxes of oxygen ions in the tail vary between ∼5% and ∼20% compared to the anti‐sunward fluxes [ABSTRACT FROM AUTHOR]

Published
2024
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10. Nature of the MHD and kinetic scale turbulence in the magnetosheath of Saturn: Cassini observations

Author

Hadid, L. Z., Sahraoui, F., Kiyani, K. H., Retinò, A., Modolo, R., Canu, P., Masters, A., and Dougherty, M. K.

Subjects
Physics - Space Physics, Astrophysics - Earth and Planetary Astrophysics, Physics - Plasma Physics
Abstract

Low frequency turbulence in Saturn's magnetosheath is investigated using in-situ measurements of the Cassini spacecraft. Focus is put on the magnetic energy spectra computed in the frequency range $\sim[10^{-4}, 1]$Hz. A set of 42 time intervals in the magnetosheath were analyzed and three main results that contrast with known features of solar wind turbulence are reported: 1) The magnetic energy spectra showed a $\sim f^{-1}$ scaling at MHD scales followed by an $\sim f^{-2.6}$ scaling at the sub-ion scales without forming the so-called inertial range; 2) The magnetic compressibility and the cross-correlation between the parallel component of the magnetic field and density fluctuations $ C(\delta n,\delta B_{||}) $ indicates the dominance of the compressible magnetosonic slow-like modes at MHD scales rather than the Alfv\'en mode; 3) Higher order statistics revealed a monofractal (resp. multifractal) behaviour of the turbulent flow downstream of a quasi-perpendicular (resp. quasi-parallel) shock at the sub-ion scales. Implications of these results on theoretical modeling of space plasma turbulence are discussed.

Published
2016
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11. Automated Multi-Dataset Analysis (AMDA): An on-line database and analysis tool for heliospheric and planetary plasma data

Author

Génot, V., Budnik, E., Jacquey, C., Bouchemit, M., Renard, B., Dufourg, N., André, N., Cecconi, B., Pitout, F., Lavraud, B., Fedorov, A., Ganfloff, M., Plotnikov, I., Modolo, R., Lormant, N., Mohand, H. Si Hadj, Tao, C., Besson, B., Heulet, D., Boucon, D., Durand, J., Bourrel, N., Brzustowski, Q., Jourdane, N., Hitier, R., Garnier, P., Grison, B., Aunai, N., Jeandet, A., and Cabrolie, F.

Published
2021
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17. White coat syndrome and its variations: differences and clinical impact

Author

Pioli MR, Ritter AMV, de Faria AP, and Modolo R

Subjects
Hypertension, white coat effect, white coat hypertension, masked hypertension, cardiovascular risk, Internal medicine, RC31-1245
Abstract

Mariana R Pioli,1 Alessandra MV Ritter,1 Ana Paula de Faria,1 Rodrigo Modolo1,2 1Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil; 2Laboratory of Cardiac Catheterization, Department of Internal Medicine, Cardiology Division, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil Abstract: Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of individuals present a variation on blood pressure (BP) levels when they are assessed either in the office or in the out-of-office settings. This phenomenon is defined as white coat syndrome – a change in BP levels due to the presence of a physician or other health professional. In this context, the term “white coat syndrome” may refer to three important and different clinical conditions: 1) white coat hypertension, 2) white coat effect, and 3) masked hypertension. The development of TOD and the increased cardiovascular risk play different roles in these specific subgroups of white coat syndrome. Correct diagnose and clinical guidance are essential to improve the prognosis of these patients. The aim of this review was to elucidate contemporary aspects of these types of white coat syndrome on general and hypertensive population. Keywords: hypertension, white coat effect, white coat hypertension, masked hypertension, cardiovascular risk

Published
2018

20. Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists

Author

Yugar-Toledo JC, Modolo R, de Faria AP, and Moreno H

Subjects
Resistant hypertension, aldosterone, hyperaldosteronism, mineralocorticoid receptor antagonists, spironolactone, eplerenone., Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Juan Carlos Yugar-Toledo,1 Rodrigo Modolo,2 Ana Paula de Faria,2 Heitor Moreno2 1São José do Rio Preto Medicine School – FAMERP, São José do Rio Preto, 2School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil Abstract: Mineralocorticoid-receptor antagonists (MRAs) have proven to be effective in some types of hypertension, especially in resistant hypertension (RHTN). In this phenotype of hypertension, the renin–angiotensin–aldosterone pathway plays an important role, with MRAs being especially effective in reducing blood pressure. In this review, we show the relevance of aldosterone in RHTN, as well as some clinical characteristics of this condition and the main concepts involving its pathophysiology and cardiovascular damage. We analyzed the mechanisms of action and clinical effects of two current MRAs – spironolactone and eplerenone – both of which are useful in RHTN, with special attention to the former. RHTN represents a significant minority (10%–15%) of hypertension cases. However, primary-care physicians, cardiologists, nephrologists, neurologists, and geriatricians face this health problem on a daily basis. MRAs are likely one of the best pharmacological options in RHTN patients; however, they are still underused. Keywords: resistant hypertension, aldosterone, aldosteronism, mineralocorticoid-receptor antagonists, spironolactone, eplerenone

Published
2017

21. Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement.

Author

Abdelshafy, M., Serruys, P.W., Tsai, T.Y., Revaiah, P.C., Garg, S., Aben, J.P., Schultz, C.J., Abdelghani, M., Tonino, P.A.L., Miyazaki, Y., Rutten, M.C.M., Cox, M., Sahyoun, C., Teng, J., Tateishi, H., Abdel-Wahab, M., Piazza, N., Pighi, M., Modolo, R., Mourik, M. van, Wykrzykowska, J., Winter, R.J. de, Lemos, P.A., Brito FS, J.r. de, Kawashima, H., Søndergaard, L., Rosseel, L., Wang, R., Gao, C., Tao, L., Rück, A., Kim, W.K., Royen, N. van, Terkelsen, C.J., Nissen, H., Adam, M., Rudolph, T.K., Wienemann, H., Torii, R., Josef Neuman, F., Schoechlin, S., Chen, M., Elkoumy, A., Elzomor, H., Amat-Santos, I.J., Mylotte, D., Soliman, O., Onuma, Y., Abdelshafy, M., Serruys, P.W., Tsai, T.Y., Revaiah, P.C., Garg, S., Aben, J.P., Schultz, C.J., Abdelghani, M., Tonino, P.A.L., Miyazaki, Y., Rutten, M.C.M., Cox, M., Sahyoun, C., Teng, J., Tateishi, H., Abdel-Wahab, M., Piazza, N., Pighi, M., Modolo, R., Mourik, M. van, Wykrzykowska, J., Winter, R.J. de, Lemos, P.A., Brito FS, J.r. de, Kawashima, H., Søndergaard, L., Rosseel, L., Wang, R., Gao, C., Tao, L., Rück, A., Kim, W.K., Royen, N. van, Terkelsen, C.J., Nissen, H., Adam, M., Rudolph, T.K., Wienemann, H., Torii, R., Josef Neuman, F., Schoechlin, S., Chen, M., Elkoumy, A., Elzomor, H., Amat-Santos, I.J., Mylotte, D., Soliman, O., and Onuma, Y.

Abstract

Contains fulltext : 296015.pdf (Publisher’s version ) (Open Access), Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.

Published
2023

25. Juno Magnetometer Observations at Ganymede: Comparisons With a Global Hybrid Simulation and Indications of Magnetopause Reconnection

Author

Romanelli, N., primary, DiBraccio, G. A., additional, Modolo, R., additional, Connerney, J. E. P., additional, Ebert, R. W., additional, Martos, Y. M., additional, Weber, T., additional, Espley, J. R., additional, Kurth, W. S., additional, Allegrini, F., additional, Valek, P., additional, and Bolton, S. J., additional

Published
2022
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26. Ambipolar electrostatic field in dusty plasma – CORRIGENDUM

Author

Hadid, L.Z., primary, Shebanits, O., additional, Wahlund, J.-E., additional, Morooka, M.W., additional, Nagy, A.F., additional, Farrell, W.M., additional, Holmberg, M.K.G., additional, Modolo, R., additional, Persoon, A.M., additional, Tseng, W.L., additional, and Ye, S.-Y., additional

Published
2022
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27. Recovery Timescales of the Dayside Martian Magnetosphere to IMF Variability

Author

Romanelli, N, DiBraccio, G, Modolo, R, Leblanc, F, Espley, J, Gruesbeck, J, Halekas, J, Mcfadden, J, and Jakosky, B

Subjects
Lunar And Planetary Science And Exploration
Abstract

In this work we revisit an event observed by Mars Atmosphere and Volatile Evolution MissioNin the solar wind where the interplanetary magneticfield (IMF) rotates around the Mars‐Sun axis during∼6 min. Based on a time‐dependent LATMOS Hybrid Simulation, we determine recovery timescales of thedayside Martian magnetosphere normalized by the IMF variability timescale. Particularly, wefind thatsuch recovery timescales range between 8 s and 11 min for an∼90° IMF rotation that lasted 50 s (observed aspart of the 6‐min time interval), depending on the considered magnetospheric region. We alsofind thatthe O+plume recovery timescales range between 40 and 120 s, taking greater values for further downstreamdistances (at least up to 1RMdownstream from the terminator plane). This range is on the order of themagnetosheath O+gyroperiod, showing the kinetic nature of the plume recovery process.

Published
2019
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28. Early MAVEN Deep Dip campaign reveals thermosphere and ionosphere variability

Author

Bougher, S., Jakosky, B., Halekas, J., Grebowsky, J., Luhmann, J., Mahaffy, P., Connerney, J., Eparvier, F., Ergun, R., Larson, D., McFadden, J., Mitchell, D., Schneider, N., Zurek, R., Mazelle, C., Andersson, L., Andrews, D., Baird, D., Baker, D. N., Bell, J. M., Benna, M., Brain, D., Chaffin, M., Chamberlin, P., Chaufray, J.-Y., Clarke, J., Collinson, G., Combi, M., Crary, F., Cravens, T., Crismani, M., Curry, S., Curtis, D., Deighan, J., Delory, G., Dewey, R., DiBraccio, G., Dong, C., Dong, Y., Dunn, P., Elrod, M., England, S., Eriksson, A., Espley, J., Evans, S., Fang, X., Fillingim, M., Fortier, K., Fowler, C. M., Fox, J., Gröller, H., Guzewich, S., Hara, T., Harada, Y., Holsclaw, G., Jain, S. K., Jolitz, R., Leblanc, F., Lee, C. O., Lee, Y., Lefevre, F., Lillis, R., Livi, R., Lo, D., Ma, Y., Mayyasi, M., McClintock, W., McEnulty, T., Modolo, R., Montmessin, F., Morooka, M., Nagy, A., Olsen, K., Peterson, W., Rahmati, A., Ruhunusiri, S., Russell, C. T., Sakai, S., Sauvaud, J.-A., Seki, K., Steckiewicz, M., Stevens, M., Stewart, A. I. F., Stiepen, A., Stone, S., Tenishev, V., Thiemann, E., Tolson, R., Toublanc, D., Vogt, M., Weber, T., Withers, P., Woods, T., and Yelle, R.

Published
2015

29. MAVEN observations of the response of Mars to an interplanetary coronal mass ejection

Author

Jakosky, B. M., Grebowsky, J. M., Luhmann, J. G., Connerney, J., Eparvier, F., Ergun, R., Halekas, J., Larson, D., Mahaffy, P., McFadden, J., Mitchell, D. F., Schneider, N., Zurek, R., Bougher, S., Brain, D., Ma, Y. J., Mazelle, C., Andersson, L., Andrews, D., Baird, D., Baker, D., Bell, J. M., Benna, M., Chaffin, M., Chamberlin, P., Chaufray, Y.-Y., Clarke, J., Collinson, G., Combi, M., Crary, F., Cravens, T., Crismani, M., Curry, S., Curtis, D., Deighan, J., Delory, G., Dewey, R., DiBraccio, G., Dong, C., Dong, Y., Dunn, P., Elrod, M., England, S., Eriksson, A., Espley, J., Evans, S., Fang, X., Fillingim, M., Fortier, K., Fowler, C. M., Fox, J., Gröller, H., Guzewich, S., Hara, T., Harada, Y., Holsclaw, G., Jain, S. K., Jolitz, R., Leblanc, F., Lee, C. O., Lee, Y., Lefevre, F., Lillis, R., Livi, R., Lo, D., Mayyasi, M., McClintock, W., McEnulty, T., Modolo, R., Montmessin, F., Morooka, M., Nagy, A., Olsen, K., Peterson, W., Rahmati, A., Ruhunusiri, S., Russell, C. T., Sakai, S., Sauvaud, J.-A., Seki, K., Steckiewicz, M., Stevens, M., Stewart, A. I. F., Stiepen, A., Stone, S., Tenishev, V., Thiemann, E., Tolson, R., Toublanc, D., Vogt, M., Weber, T., Withers, P., Woods, T., and Yelle, R.

Published
2015

32. Heart rate variability in children with type 1 diabetes mellitus

Author

Camila Balsamo Gardim, Bruno Affonso P. de Oliveira, Aline Fernanda B. Bernardo, Rayana Loch Gomes, Francis Lopes Pacagnelli, Roselene Modolo R. Lorençoni, and Luiz Carlos M. Vanderlei

Subjects
diabetes mellitus tipo 1, niño, sistema nervioso autónomo, variabilidad de la frecuencia cardiaca, Pediatrics, RJ1-570
Abstract

OBJECTIVE:To gather current information about the effects of type 1 diabetes mellitus on children's cardiac autonomic behavior.DATA SOURCES: The search of articles was conducted on PubMed, Ibecs, Medline, Cochrane, Lilacs, SciELO and PEDro databases using the MeSH terms: "autonomic nervous system", "diabetes mellitus", "child", "type 1 diabetes mellitus", "sympathetic nervous system" and "parasympathetic nervous system", and their respective versions in Portuguese (DeCS). Articles published from January 2003 to February 2013 that enrolled children with 9-12 years old with type 1 diabetes mellitus were included in the review.DATA SYNTHESIS: The electronic search resulted in four articles that approached the heart rate variability in children with type 1 diabetes mellitus, showing that, in general, these children present decreased global heart rate variability and vagal activity. The practice of physical activity promoted benefits for these individuals.CONCLUSIONS: Children with type 1 diabetes mellitus present changes on autonomic modulation, indicating the need for early attention to avoid future complications in this group.

Published
2014
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33. Characterizing Atmospheric Escape from Mars Today and Through Time, with MAVEN

Author

Lillis, R. J., Brain, D. A., Bougher, S. W., Leblanc, F., Luhmann, J. G., Jakosky, B. M., Modolo, R., Fox, J., Deighan, J., Fang, X., Wang, Y. C., Lee, Y., Dong, C., Ma, Y., Cravens, T., Andersson, L., Curry, S. M., Schneider, N., Combi, M., Stewart, I., Clarke, J., Grebowsky, J., Mitchell, D. L., Yelle, R., Nagy, A. F., Baker, D., and Lin, R. P.

Published
2015
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34. Ambipolar electrostatic field in negatively charged dusty plasma

Author

Hadid, L. Z., Shebanits, Oleg, Wahlund, J-E, Morooka, Michiko, Nagy, A. F., Farrell, W. M., Holmberg, M. K. G., Modolo, R., Persoon, A. M., Tseng, W. L., Ye, S-Y, Hadid, L. Z., Shebanits, Oleg, Wahlund, J-E, Morooka, Michiko, Nagy, A. F., Farrell, W. M., Holmberg, M. K. G., Modolo, R., Persoon, A. M., Tseng, W. L., and Ye, S-Y

Abstract

We study the effect of negatively charged dust on the magnetic-field-aligned polarisation electrostatic field (E-parallel to) using Cassini's RPWS/LP in situ measurements during the `ring-grazing' orbits. We derive a general expression for E-parallel to and estimate for the first time in situ parallel to E-parallel to parallel to (approximately 10(-5) V m(-1)) near the Janus and Epimetheus rings. We further demonstrate that the presence of the negatively charged dust close to the ring plane (vertical bar Z vertical bar less than or similar to 0.11 R-s) amplifies parallel to E-parallel to parallel to by at least one order of magnitude and reverses its direction due to the effect of the charged dust gravitational and inertial forces. Such reversal confines the electrons at the magnetic equator within the dusty region, around 0.047 R-s above the ring plane. Furthermore, we discuss the role of the collision terms, in particular the ion-dust drag force, in amplifying E-parallel to. These results imply that the charged dust, as small as nanometres in size, can have a significant influence on the plasma transport, in particular ambipolar diffusion along the magnetic field lines, and so their presence must be taken into account when studying such dynamical processes.

Published
2022
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36. Ambipolar electrostatic field in dusty plasma – ERRATUM

Author

Hadid, L.Z., primary, Shebanits, O., additional, Wahlund, J.-E., additional, Morooka, M.W., additional, Nagy, A.F., additional, Farrell, W.M., additional, Holmberg, M.K.G., additional, Modolo, R., additional, Persoon, A.M., additional, Tseng, W.L., additional, and Ye, S.-Y., additional

Published
2022
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47. The ultra-thin strut sirolimus-eluting coronary stent: SUPRAFLEX

Author

Gao, C., Kogame, N., Modolo, R., Takahashi, K., Wang, R., Kawashima, H., Ono, M., Hara, H., Tomaniak, M., Zaman, A., Winter, R.J. de, Geuns, R.J.M. van, Kaul, U., Serruys, P.W., Onuma, Y., Gao, C., Kogame, N., Modolo, R., Takahashi, K., Wang, R., Kawashima, H., Ono, M., Hara, H., Tomaniak, M., Zaman, A., Winter, R.J. de, Geuns, R.J.M. van, Kaul, U., Serruys, P.W., and Onuma, Y.

Abstract

Item does not contain fulltext, Percutaneous coronary interventions with drug-eluting stents is currently the preferred revascularization treatment strategy for coronary artery disease. Following the first generation, the second-generation drug-eluting stents was designed with a thinner strut, better biocompatible polymer with/without bioresorbable coating or even polymer-free struts. The SUPRAFLEX stent system has ultra-thin struts (60 μm) across all stent diameters and a biodegradable polymer coating, enabling 70% of the sirolimus elution within 7 days. SUPRAFLEX has been assessed in large scale randomized controlled trials. This review summarizes the design of the SUPRAFLEX stent, the results of the pivotal clinical trials and outlines the ongoing research programs.

Published
2021

48. Influence of Bleeding Risk on Outcomes of Radial and Femoral Access for Percutaneous Coronary Intervention: An Analysis From the GLOBAL LEADERS Trial

Author

Gao, C, Buszman, P, Buszman, PA, Chichareon, P, Modolo, R, Garg, S, Takahashi, K, Kawashima, H, Wang, R, Chang, CC, Kogame, N, Tomaniak, Mariusz, Ono, M, Hara, H, Slagboom, T, Aminian, A, Naber, CK, Carrie, D, Hamm, C, Steg, PG, Onuma, Yoshinobu, van Geuns, RJ, Serruys, PWJC, Zurakowski, A, Gao, C, Buszman, P, Buszman, PA, Chichareon, P, Modolo, R, Garg, S, Takahashi, K, Kawashima, H, Wang, R, Chang, CC, Kogame, N, Tomaniak, Mariusz, Ono, M, Hara, H, Slagboom, T, Aminian, A, Naber, CK, Carrie, D, Hamm, C, Steg, PG, Onuma, Yoshinobu, van Geuns, RJ, Serruys, PWJC, and Zurakowski, A

Abstract

Background: Radial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding. Methods: Patients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days. Results: In the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; Pinteraction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; Pinteraction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant. Conclusions: Our findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because this was not a primary analysis, it should be considered hypothesis generating.

Published
2021

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