Coronary
Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials

https://doi.org/10.1016/j.jcin.2016.04.014Get rights and content
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Abstract

Objectives

The aim of this study was to provide a quantitative appraisal of the effects on clinical outcomes of radial access for coronary interventions in patients with coronary artery disease (CAD).

Background

Randomized trials investigating radial versus femoral access for percutaneous coronary interventions have provided conflicting evidence. No comprehensive quantitative appraisal of the risks and benefits of each approach is available across the whole spectrum of patients with stable or unstable CAD.

Methods

The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized trials comparing radial versus femoral access for coronary interventions. Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Pre-specified subgroup analyses according to clinical presentation, in terms of stable CAD, non–ST-segment elevation acute coronary syndromes, or ST-segment elevation myocardial infarction were performed.

Results

Twenty-four studies enrolling 22,843 participants were included. Compared with femoral access, radial access was associated with a significantly lower risk for all-cause mortality (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.87; p = 0.001, number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR: 0.84; 95% CI: 0.75 to 0.94; p = 0.002; NNTB = 99), major bleeding (OR: 0.53; 95% CI: 0.42 to 0.65; p < 0.001; NNTB = 103), and major vascular complications (OR: 0.23; 95% CI: 0.16 to 0.35; p < 0.001; NNTB = 117). The rates of myocardial infarction or stroke were similar in the 2 groups. Effects of radial access were consistent across the whole spectrum of patients with CAD for all appraised endpoints.

Conclusions

Compared with femoral access, radial access reduces mortality and MACE and improves safety, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.

Key Words

bleeding
femoral access
percutaneous coronary intervention
radial access
vascular complications

Abbreviations and Acronyms

ACS
acute coronary syndrome(s)
CI
confidence interval
MACE
major adverse cardiovascular event(s)
NACE
net adverse clinical event(s)
NSTE
non–ST-segment elevation
NNTB
number of patients needed to treat for an additional beneficial outcome
OR
odds ratio
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

Dr. Jüni has received research grants to the institution from AstraZeneca, Biotronik, Biosensors International, Eli Lilly, and The Medicines Company; and serves as an unpaid member of the steering groups of trials funded by AstraZeneca, Biotronik, Biosensors International, St. Jude Medical, and The Medicines Company. Dr. Valgimigli has received institutional grants from The Medicines Company and Terumo for the MATRIX trial. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.