Studies in patients with acute coronary syndrome (ACS) undergoing invasive management showed conflicting conclusions regarding the effect of access site on outcomes.
To summarize evidence from recent, high-quality trials that compared clinical outcomes occurring with radial versus femoral access in invasively managed adults with ACS.
English-language publications in MEDLINE, EMBASE, and Cochrane databases between January 1990 and August 2015.
Randomized trials of radial versus femoral access in invasively managed patients with ACS.
Two investigators independently extracted the study data and rated the risk of bias.
Of 17 identified randomized trials, 4 were high-quality multicenter trials that involved a total of 17 133 patients. Pooled data from the 4 trials showed that radial access reduced death (relative risk [RR], 0.73 [95% CI, 0.59 to 0.90]; P = 0.003), major adverse cardiovascular events (RR, 0.86 [CI, 0.75 to 0.98]; P = 0.025), and major bleeding (RR, 0.57 [CI, 0.37 to 0.88]; P = 0.011). Radial procedures lasted slightly longer (standardized mean difference, 0.11 minutes) and had higher risk for access-site crossover (6.3% vs. 1.7%) than did femoral procedures.
Heterogeneity in outcomes definitions and potential treatment modifiers across studies, including operator experience in radial procedures and concurrent anticoagulant regimens.
Compared with femoral access, radial access reduces mortality, major adverse cardiovascular events, and major bleeding in patients with ACS undergoing invasive management.
Primary Funding Source:
None. (PROSPERO registration number: CRD42015022031)
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Author, Article and Disclosure Information
From the University of Messina, Messina, and Ferrarotto Hospital, University of Catania, Catania, Italy.
Grant Support: The authors are funded by their academic institutions.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1277.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Corresponding Author: Giuseppe Andò, MD, PhD, Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, c/o Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Via Consolare Valeria, 98124 Messina, Italy; e-mail, giuseppe.
Current Author Addresses: Dr. Andò: Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, c/o Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino,” Via Consolare Valeria, 98124 Messina, Italy.
Professor Capodanno: Department of General Surgery and Medical-Surgical Specialties, University of Catania, c/o Ospedale Ferrarotto, Via Salvatore Citelli 31, 95124 Catania, Italy.
Author Contributions: Conception and design: G. Andò.
Analysis and interpretation of the data: G. Andò, D. Capodanno.
Drafting of the article: G. Andò, D. Capodanno.
Critical revision of the article for important intellectual content: D. Capodanno.
Final approval of the article: G. Andò, D. Capodanno.
Statistical expertise: G. Andò.
Collection and assembly of data: G. Andò.
This article was published online first at www.annals.org on 10 November 2015.