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Radial versus femoral access for coronary interventions: An updated systematic review and meta-analysis of randomized
Mauro Chiarito1,2, Davide Cao1, Johny Nicolas1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Radial access significantly reduces bleeding, vascular complications, and mortality compared to femoral access during coronary angiography and percutaneous coronary intervention (PCI). Stroke and myocardial infarction risks remain comparable between methods.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The debate continues regarding whether benefits of radial versus femoral access for coronary angiography and percutaneous coronary interventions (PCI) stem from access site choice, operator skill, or other factors.
- Understanding the comparative safety and efficacy of different vascular access routes is crucial for optimizing patient outcomes.
Purpose of the Study:
- To systematically evaluate the safety and efficacy of radial versus femoral access in patients undergoing coronary angiography and PCI.
- To compare key clinical outcomes including major bleeding, stroke, myocardial infarction (MI), mortality, and vascular complications.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, and meeting abstracts for relevant randomized trials.
- Meta-analysis of 31 randomized trials involving 30,096 patients (21,225 undergoing PCI) was performed.
- Primary safety endpoint was major bleeding; coprimary efficacy endpoints were stroke and MI.
Main Results:
- Radial access demonstrated a significant reduction in major bleeding (OR 0.53) compared to femoral access, with consistent findings across subgroups.
- No significant difference in the risk of stroke (OR 1.11) or MI (OR 0.90) was observed between radial and femoral access.
- Radial access was associated with significantly lower risks of mortality and vascular complications.
Conclusions:
- Radial access offers significant advantages over femoral access for coronary angiography and PCI, primarily through reduced bleeding, vascular complications, and mortality.
- While radial access improves safety endpoints, the risks of stroke and MI are similar to femoral access.
Objective:
It is still debated if benefits associated with radial versus femoral access for coronary angiography and percutaneous coronary interventions (PCI) are due to the access site selection itself, operator expertise or other underlying mechanisms.
Methods:
We searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access site for coronary angiography and PCI. Primary safety endpoint was major bleeding. Coprimary efficacy endpoints were stroke and myocardial infarction (MI). This study is registered with PROSPERO.
Results:
We identified 31 trials (30,096 patients, PCI performed in 21,225 patients). Radial compared to femoral access was associated with a significant risk reduction in major bleeding (OR 0.53, 95%CI 0.42-0.66, I2 = 3.3%). Findings were consistent regardless of clinical characteristics or whether coronary angiography was performed with or without PCI. The benefit of radial access was significantly increased in studies published before 2010 and in patients with chronic coronary syndrome. Risk for stroke (OR 1.11, 95%CI 0.76-1.64, I2 = 0%) and MI (OR 0.90, 95%CI 0.79-1.04, I2 = 0%) were comparable between the groups. Risk for mortality and vascular complications were significantly lower with radial than femoral access.
Conclusion:
In patients undergoing coronary angiography and PCI, radial access is associated with a significant risk reduction in bleeding, vascular complications, and mortality compared to femoral access. The risk of stroke or MI were comparable in patients with radial or femoral access.
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