Sex Differences in Access-site and Clinical Outcomes Following Transradial Percutaneous Coronary Intervention: A...

Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with lower rates of bleeding and vascular complications than transfemoral access. However, it remains uncertain whether radial (including distal) access fully mitigates these established sex-based disparities in PCI outcomes. We performed a systematic review and meta-analysis to evaluate sex-specific procedural, access-site, and clinical outcomes following radial and distal radial PCI. PubMed, Embase, and Cochrane databases were searched from inception through October 2025 for randomized controlled trials and observational studies reporting PCI outcomes stratified by sex in patients undergoing radial or distal radial access. Outcomes were categorized as procedural, access-site safety, and clinical endpoints. Pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Study quality was assessed using the ROBINS-I tool. Nine studies comprising 214,638 patients (52,486 women and 162,152 men) were included. Compared with men, women had higher rates of access-site crossover (RR 1.87, 95% CI 1.58 to 2.22) and slightly lower procedural success (RR 0.98, 95% CI 0.97 to 0.99), despite shorter procedure duration (MD -3.62 minutes, 95% CI -7.21 to -0.04). Women experienced significantly higher rates of access-site bleeding (RR 1.84, 95% CI 1.23 to 2.75), hematoma (RR 1.70, 95% CI 1.00 to 2.91), and radial artery spasm (RR 3.40, 95% CI 1.30 to 8.87), while radial artery perforation did not differ by sex. Clinically, women had higher cardiovascular mortality (RR 1.75, 95% CI 1.14 to 2.69) and major bleeding (RR 1.51, 95% CI 1.24 to 1.84), but unexpectedly lower target vessel revascularization (RR 0.59, 95% CI 0.36 to 0.95). Rates of all-cause mortality, myocardial infarction, stroke, and major adverse cardiac events were similar between sexes. In conclusion, women undergoing PCI via radial or distal radial access experienced higher rates of access-site complications, major bleeding, and cardiovascular mortality than men, whereas ischemic outcomes were generally similar between sexes. These findings suggest that sex-related differences may persist despite the widespread use of radial access. However, the contribution of vascular access itself to these differences remains uncertain, as other clinical and procedural factors may also influence outcomes.