Reviews15 December 2015
A Systematic Review and Meta-analysis
    Author, Article and Disclosure Information

    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.

    Data Sources:

    English-language publications in MEDLINE, EMBASE, and Cochrane databases between January 1990 and August 2015.

    Study Selection:

    Randomized trials of radial versus femoral access in invasively managed patients with ACS.

    Data Extraction:

    Two investigators independently extracted the study data and rated the risk of bias.

    Data Synthesis:

    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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