Related Experiment Video
Updated: Mar 22, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Radial Access Reduces Mortality in Patients With Acute Coronary Syndromes: Results From an Updated Trial Sequential
Giuseppe Andò1, Davide Capodanno2
1Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy.
Insights
Radial access significantly reduces mortality and major bleeding in acute coronary syndrome (ACS) patients undergoing cardiac catheterization. This approach is supported by robust evidence as a superior bleeding avoidance strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Conflicting conclusions exist regarding the ischemic benefits of radial access in acute coronary syndrome (ACS) patients.
- Radial access is established as a bleeding avoidance strategy.
Purpose of the Study:
- To determine if cumulative evidence supports radial access as a strategy to reduce mortality and ischemic events in ACS patients.
- To assess if radial access offers a mortality benefit beyond its known bleeding reduction advantages.
Main Methods:
- Meta-analysis of 17 randomized studies including 19,328 patients published up to October 2015.
- Utilized classic and trial sequential analysis techniques to evaluate statistical power and clinical significance.
Main Results:
- Radial access significantly reduced mortality (RR: 0.73; 95% CI: 0.60-0.88) and major adverse cardiovascular events (RR: 0.86; 95% CI: 0.77-0.95).
- A significant reduction in major bleeding was observed (RR: 0.60; 95% CI: 0.48-0.76).
- Trial sequential analysis indicated firm evidence for a meaningful mortality reduction with radial access.
Conclusions:
- Radial access is associated with reduced mortality compared to femoral access in ACS patients requiring invasive procedures.
- The benefits of reduced mortality and major adverse cardiovascular events, alongside decreased bleeding, support radial access as the preferred strategy for cardiac catheterization in ACS.
Objectives:
The authors sought to investigate whether the cumulative evidence coming from randomized studies has reached the necessary power to consider radial access as a bleeding avoidance strategy that reduces mortality and ischemic endpoints in patients with acute coronary syndromes (ACS).
Background:
Studies in ACS patients have reached conflicting conclusions about the impact of radial access in improving ischemic outcomes in addition to the established bleeding benefit.
Methods:
English-language publications and abstracts of major cardiovascular meetings until October 2015 were scrutinized. Study quality, patient characteristics, procedural data, and outcomes were extracted. Data were pooled in random effects meta-analyses with classic and trial sequential techniques. Trial sequential analysis combines the a priori information size calculation needed to allow for clinically meaningful statistical inference with the adjustment of thresholds for which results are considered significant.
Results:
Seventeen studies, encompassing data from 19,328 patients, were pooled. Radial access was found to reduce mortality (relative risk [RR]: 0.73; 95% confidence interval [CI]: 0.60 to 0.88; p = 0.001), major adverse cardiovascular events (RR: 0.86; 95% CI: 0.77 to 0.95; p = 0.005), and major bleeding (RR: 0.60; 95% CI: 0.48 to 0.76; p < 0.001). Multiple sensitivity analyses showed consistent results, and trial sequential analysis suggested firm evidence for a meaningful reduction in mortality with radial access.
Conclusions:
Radial access reduces mortality compared with femoral access in ACS patients undergoing invasive management. This benefit is paralleled by consistent reductions in major adverse cardiovascular events and major bleeding, supporting radial access as the default strategy for cardiac catheterization in patients with ACS.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
08:50Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:26Acute Coronary Syndrome V: Nursing Management