***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION AND OBJECTIVES The right radial ( RR ) approach has been incorporated into daily clinical practice as a valid alternative to the femoral ( F ) approach . The left radial ( LR ) approach is seldom used and few data are available from r and omized studies comparing this approach with F and RR approaches . METHODS We r and omized 1005 consecutive patients referred to a tertiary-care hospital for cardiac catheterization to different approaches . Procedures were performed by three interventional cardiologists experienced in transradial catheterization . There were no exclusion criteria . The primary end-point was the percentage of procedures completed using the assigned approach . Secondary endpoints were the percentage completed in the absence of contraindications to any approach , the duration of the procedure , and the incidence of vascular complications . RESULTS More procedures were completed with the F approach ( LR , 71 % ; F , 92 % ; RR , 68 % ; P < .001 ) . The success rate in the absence of contraindications to any approach ( n=907 ) was greater with the F approach , with no difference between LR and RR approaches ( LR , 80 % ; F , 96 % ; RR , 82 % ; P < .001 ) . The canalization time was greater with the LR approach ( P < .001 ) , the time required for diagnosis was shorter with the F approach ( P < .001 ) and compression was faster with the radial approach ( P < .001 ) . There was no difference in the total duration of diagnostic procedures ( P=.22 ) or interventions ( P=.9 ) . The incidence of vascular complications was lower with the radial approach ( P=.03 ) . CONCLUSIONS The left radial approach is as valid an alternative to the femoral approach as the right radial approach A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Aims : The transradial ( TR ) approach has potentially lower complication rates than transfemoral ( TF ) approach coronary angiography . However , it may be technically more challenging , especially in elderly patients with alterations in vascular anatomy . We thus determined success rates , procedural data , and complication rates of TR angiography in comparison to the TF approach in elderly patients in a r and omized , prospect i ve trial . Methods and results : Four hundred consecutive patients ≥75 years with known or suspected coronary artery disease were included in the study . After exclusion of 93 patients with contraindications to the radial approach , 152 patients were r and omized to the TR and 155 to TF coronary angiography and intervention  . In 13 patients r and omized to TR , cross‐over to TF was necessary ( 9 % ) . Total examination time was significantly longer for the TR approach ( 18.1 vs. 15.0 min , P = 0.009 ) , but no difference was found for fluoroscopy time , number of catheters used , or amount of contrast agent . The rate of major complications ( bleeding requiring surgery or transfusion , stroke ) was 0 % for TR and 3.2 % for TF approach ( P < 0.001 ) . Minor complications occurred in 1.3 % versus 5.8 % of patients ( P < 0.001 ) . Conclusion : In elderly patients , TR coronary angiography and intervention has a high technical success rate and lower complication rates than the TF approach . © 2008 Wiley‐Liss , OBJECTIVES The aim of this study was to determine the economic impact of several anticoagulation strategies for moderate- and high-risk non-ST-segment elevation acute coronary syndrome ( NSTE-ACS ) patients managed invasively . BACKGROUND The ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) trial demonstrated that bivalirudin monotherapy yields similar rates of ischemic complications and less bleeding than regimens incorporating glycoprotein IIb/IIIa receptor inhibitors ( GPI ) for moderate- and high-risk NSTE-ACS . METHODS In ACUITY , 7,851 U.S. patients were r and omized to : 1 )  heparin ( unfractionated or enoxaparin ) + GPI ; 2 ) bivalirudin + GPI ; or 3 ) bivalirudin monotherapy . Patients assigned to GPI were also r and omized to upstream GPI before catheterization or selective GPI only with percutaneous coronary intervention . Re source use data were collected prospect ively through 30-day follow-up . Costs were estimated with st and ard methods including re source -based accounting , hospital billing data , and the Medicare fee schedule . RESULTS At 30 days , ischemic events were similar for all groups . Major bleeding was reduced with bivalirudin monotherapy compared with heparin + GPI or bivalirudin + GPI ( p < 0.001 ) . Length of stay was lowest with bivalirudin monotherapy or bivalirudin + catheterization laboratory GPI ( p = 0.02 ) . Despite higher drug costs , aggregate hospital stay costs were lowest with bivalirudin monotherapy ( mean difference range : $ 184 to $ 1,081 , p < 0.001 for overall comparison ) and at 30 days ( mean difference range : $ 123 to $ 938 , p = 0.005 ) . Regression modeling demonstrated that hospital savings were primarily due to less major and minor bleeding with bivalirudin ( $ 8,658/event and $ 2,282/event , respectively ) . CONCLUSIONS Among U.S. patients in the ACUITY trial , bivalirudin monotherapy compared with heparin + GPI result ed in similar protection from ischemic events , reduced bleeding , and shorter length of stay . Despite higher drug costs , aggregate hospital and 30-day costs were lowest with bivalirudin monotherapy . Thus bivalirudin monotherapy seems to be an economically attractive alternative to heparin + GPI for patients with moderate- and high-risk NSTE-ACS . ( Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ ACS ] ; NCT00093158 ) Background — The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation ( FAME ) study demonstrated significantly improved health outcomes at 1 year in patients r and omized to multivessel percutaneous coronary intervention  guided by fractional flow reserve ( FFR ) compared with percutaneous coronary intervention guided by angiography alone . The economic impact of routine measurement of FFR in this setting is not known . Methods and Results — In this study , 1005 patients were r and omly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year . A prospect i ve cost-utility analysis comparing costs and quality -adjusted life-years was performed with a time horizon of 1 year . Quality -adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights . Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up . Confidence intervals for both quality -adjusted life-years and costs were estimated by the bootstrap percentile method . Major adverse cardiac events at 1 year occurred in 13.2 % of those in the FFR-guided arm and 18.3 % of those in the angiography-guided arm ( P=0.02 ) . Quality -adjusted life-years were slightly greater in the FFR-guided arm ( 0.853 versus 0.838 ; P=0.2 ) . Mean overall costs at 1 year were significantly less in the FFR-guided arm ( $ 14 315 versus $ 16 700 ; P<0.001 ) . Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 90.74 % and cost-effective at a threshold of US $ 50 000 per quality -adjusted life-years in 99.96 % . Sensitivity analyses demonstrated robust results . Conclusion — Economic evaluation of the FAME study reveals that FFR-guided percutaneous coronary intervention in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves re sources . Clinical Trial Registration — URL : http:// Clinical Trials.gov . Unique identifier : NCT00267774 This prospect i ve multicenter study was conducted to compare the incidence of significant vascular complications delaying hospital discharge after coronary angiography and percutaneous coronary intervention ( PCI )  between the radial approach ( n = 192 ) and the femoral approach ( n = 185 ) in octogenarians , a rapidly growing population with numerous risk factors for complications . By intention-to-treat analysis , the incidence of vascular complications was found to be significantly less in the radial group ( 1.6 % vs 6.5 % , p = 0.03 ) , without any decrease in the efficacy of PCI  and only a slight increase in procedure duration for coronary angiography . All vascular complications , except for 1 , occurred in patients treated with the transfemoral approach Radial access and closure devices are associated with improved quality of life ( QOL )  after cardiac catheterization . Whether this is related to the access site or time to ambulation is unknown . Seventy‐five patients undergoing cardiac catheterization were r and omized to femoral 6 Fr with AngioSeal closure ( F+C ) , femoral 4 Fr without closure , and radial ( R ) access . All patients were ambulated at 1 hr . QOL was measured utilizing visual analogue scales and Short Form‐36 at baseline , 1 day , and 1 week . Time to ambulation and discharge were equivalent , as was postprocedure QOL . However , angiographic quality was lower in the 4 Fr group ( P < 0.0001 ) and catheterization costs were higher in the F+C group ( P < 0.0001 ) . Ambulation 1 hr after catheterization can be accomplished utilizing radial , femoral 6 Fr with closure device , or femoral 4 Fr access with equivalent outcomes and QOL . However , this is achieved at a higher cost with a closure device , or lesser angiographic quality with 4 Fr catheters . Catheter Cardiovasc Interv 2004;62:143–149 . © 2004 Wiley‐Liss , OBJECTIVES This study sought to compare procedural and clinical outcomes of percutaneous transluminal coronary angioplasty ( PTCA )  performed with 6F guiding catheters introduced through the radial , brachial or femoral arteries . BACKGROUND Transradial PTCA has been demonstrated to be an effective and safe alternative to transfemoral PTCA ; however , no r and omized data are currently available . METHODS A r and omized comparison between transradial , transbrachial and transfemoral PTCA with 6F guiding catheters was performed in 900 patients . Primary end points were entry site and angioplasty related . Secondary end points were quantitative coronary analysis after PTCA , procedural and fluoroscopy times , consumption of angioplasty equipment and length of hospital stay . RESULTS Successful coronary cannulation was achieved in 279 ( 93.0 % ) , 287 ( 95.7 % ) and 299 ( 99.7 % ) patients r and omized to undergo PTCA by the radial , brachial and femoral approaches , respectively . PTCA success was achieved in 91.7 % , 90.7 % and 90.7 % ( p = NS ) of patients , with 88.0 % , 87.7 % and 90.0 % event free at 1-month follow-up , respectively ( p = NS ) . Major entry site complications were encountered in seven patients ( 2.3 % ) in the transbrachial group , six ( 2.0 % ) in the transfemoral group and none in the transradial group ( p = 0.035 ) . Transradial PTCA led to asymptomatic loss of radial pulsations in nine patients ( 3 % ) . Procedural and fluoroscopy times were similar , as were consumption of guiding and balloon catheters and length of hospital stay ( [ mean + /- SD ] 1.5 + /- 2.5 , 1.8 + /- 3.8 and 1.8 + /- 4.2 days , respectively ) . CONCLUSIONS With experience , procedural and clinical outcomes of PTCA were similar for the three subgroups , but access failure is more common during transradial PTCA . Major access site complications were more frequently encountered after transbrachial and transfemoral PTCA Femoral arterial puncture is the most common access method for coronary angiography and percutaneous coronary interventions ( PCIs ) . Access complications , although infrequent , affect morbidity , mortality , costs , and length of hospital stay .  Vascular closure devices ( VCDs ) are used for rapid hemostasis and early ambulation , but there is no consensus on whether VCDs are superior to manual compression ( MC ) . A retrospective review and nested case-control study of consecutive patients undergoing elect 
    Output:
    
Radial catheterization was favored over femoral catheterization under all conditions tested .
Radial catheterization was favored over femoral catheterization in our cost-benefit analysis