Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

Outcome of Percutaneous coronary intervention and associated factors among patients with coronary artery disease in selected public hospital Addis Ababa, Ethiopia, 2022; A cross-sectional study

“…Regarding vascular access patients who underwent PCI through radial access were 62% less likely to develop complications as compared to femoral access (AOR 0.38 95%CI:0.15-0.99). The nding is similar with a study in Australia, a meta-analysis done by Bajraktari G, Rexhaj Z, Elezi S, et al and Ferrante G, Rao SV d0, Jüni P, et al (33)(34)(35).The reason maybe the use of radial access, as an alternative to femoral access, for coronary interventions reduces major bleeding and major vascular complications because of the easily compressible and super cial anatomy of this artery and improves patient comfort, with early mobility after procedures which is supported by resembling literature.…”

Outcomes of Transradial Approach in Terms of Procedural Failure, in Patients Undergoing Percutaneous Coronary Intervention

“…Studies from Pakistan report figures of 1.5% to 8.4%. 10,11 In a previously conducted study, transradial access reduced major bleeding by 73% (0.05%) and there was a trend for reductions in the composite of death, myocardial infarction (MI), or stroke (2.5%) as well as death (1.2%). 12 During percutaneous coronary intervention using transradial access, there was a tendency for a higher risk of inability to cross the lesion with wire, balloon, or stent (4.7%).…”

Same-day discharge percutaneous coronary intervention. Where are we?

“…The access route is also a relevant aspect in this regard, due to the solid evidence of a lower rate of bleeding complications with the use of the radial approach. 5,[17][18][19][20][21] The observation time after the procedure is, on average, 4 to 6 hours. [22][23][24] The start of the intervention should be scheduled for the early hours of the day, allowing time for the patient to be discharged.…”