Related Experiment Video
Updated: May 8, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction
Wassef Karrowni1, Ankur Vyas, Bria Giacomino
1Department of Cardiovascular Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA. wassef@hotmail.com
Insights
For ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), the radial access approach significantly reduces mortality and major bleeding compared to the femoral approach. This makes radial access the preferred method for experienced operators.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Primary percutaneous coronary intervention (PCI) is a crucial treatment for ST-segment elevation myocardial infarction (STEMI).
- The choice between radial and femoral access for primary PCI in STEMI patients has been debated due to inconclusive trial results.
- Numerous studies have investigated these approaches, necessitating a comprehensive meta-analysis.
Purpose of the Study:
- To determine the safety and efficacy of radial access versus femoral access for primary PCI in STEMI patients.
- To compare key clinical outcomes, including mortality and bleeding events, between the two access methods.
- To provide evidence-based recommendations for interventional cardiologists.
Main Methods:
- A meta-analysis of randomized controlled trials involving STEMI patients undergoing primary PCI.
- Inclusion of twelve studies with a total of 5,055 participants.
- Evaluation of primary outcomes: death and major bleeding; secondary outcomes: access site bleeding, stroke, and procedure time.
Main Results:
- Radial access was associated with significantly lower mortality rates (2.7% vs. 4.7%) and major bleeding (1.4% vs. 2.9%) compared to femoral access.
- Access site bleeding was also reduced with radial access (2.1% vs. 5.6%).
- Procedure time was slightly longer with radial access (mean difference: 1.52 min), while stroke risk remained similar between groups.
Conclusions:
- The radial approach offers favorable outcomes for STEMI patients undergoing primary PCI.
- Radial access is recommended as the preferred approach for experienced radial operators.
- This meta-analysis supports the widespread adoption of radial access in STEMI interventions.
Objectives:
This study sought to determine the safety and efficacy of radial access compared with femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Background:
Numerous randomized controlled trials, including several new studies, have compared outcomes of these approaches in the context of primary PCI for STEMI patients with inconclusive results.
Methods:
We performed a meta-analysis of randomized controlled trials to compare outcomes in STEMI patients undergoing radial versus femoral access for primary PCI. Primary outcomes were death and major bleeding evaluated at the longest available follow-up. Secondary outcomes included access site bleeding, stroke, and procedure time. Twelve studies (N = 5,055) were included. All trials were conducted in centers experienced with both approaches.
Results:
Compared with femoral approach, radial approach was associated with decreased risk of mortality (2.7% vs. 4.7%; odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.40 to 0.76; p < 0.001) and decreased risk of major bleeding (1.4% vs. 2.9%; OR: 0.51, 95% CI: 0.31 to 0.85; p = 0.01). Radial access was also associated with reduction in relative risk of access site bleeding (2.1% vs. 5.6%; OR: 0.35, 95% CI: 0.25 to 0.50; p < 0.001). Stroke risk was similar between both approaches (0.5% vs. 0.5%; OR: 1.07, 95% CI: 0.45 to 2.54; p = 0.87). The procedure time was slightly longer in the radial group than in the femoral group (mean difference: 1.52 min; 95% CI: 0.33 to 2.70, p = 0.01).
Conclusions:
In STEMI patients undergoing primary PCI, the radial approach is associated with favorable outcomes and should be the preferred approach for experienced radial operators.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care
01:24Cardiac Catheterization III: Left Heart Catheterization