Elsevier

American Heart Journal

Volume 157, Issue 1, January 2009, Pages 132-140
American Heart Journal

Clinical Investigation
Interventional Cardiology
Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials

https://doi.org/10.1016/j.ahj.2008.08.023Get rights and content

Background

Small randomized trials have demonstrated that radial access reduces access site complications compared to a femoral approach. The objective of this meta-analysis was to determine if radial access reduces major bleeding and as a result can reduce death and ischemic events compared to femoral access.

Methods

MEDLINE, EMBASE, and CENTRAL were searched from 1980 to April 2008. Relevant conference abstracts from 2005 to April 2008 were searched. Randomized trials comparing radial versus femoral access coronary angiography or intervention that reported major bleeding, death, myocardial infarction, and procedural or fluoroscopy time were included. A fixed-effects model was used with a random effects for sensitivity analysis.

Results

Radial access reduced major bleeding by 73% compared to femoral access (0.05% vs 2.3%, OR 0.27 [95% CI 0.16, 0.45], P < .001). There was a trend for reductions in the composite of death, myocardial infarction, or stroke (2.5% vs 3.8%, OR 0.71 [95% CI 0.49-1.01], P = .058) as well as death (1.2% vs 1.8% OR 0.74 [95% CI 0.42-1.30], P = .29). There was a trend for higher rate of inability to the cross lesion with wire, balloon, or stent during percutaneous coronary intervention with radial access (4.7% vs 3.4% OR 1.29 [95% CI 0.87, 1.94], P = .21). Radial access reduced hospital stay by 0.4 days (95% CI 0.2-0.5, P = .0001).

Conclusions

Radial access reduced major bleeding and there was a corresponding trend for reduction in ischemic events compared to femoral access. Large randomized trials are needed to confirm the benefit of radial access on death and ischemic events.

Section snippets

Search strategy for identification of studies

MEDLINE, CENTRAL, and EMBASE were searched for eligible studies between 1980 to April 2008, week 2. A sensitive search strategy with no language restriction was used. Conference abstracts for the American Heart Association, American College of Cardiology, Transcatheter Therapeutics, and European Society of Cardiology were hand-searched from January 2003 to April 2008. Prior systematic reviews and other studies references were hand-searched to include all relevant studies.

Eligibility criteria

We selected all

Results

As shown in Figure 1, 376 abstracts were retrieved from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and hand-searching conference proceedings and reviews, and 28 were chosen for full text review. Of the 28 chosen for full text review, 23 randomized trials based on the inclusion criteria were selected (Table I). Two trials were excluded because on full text review, they were not randomized trials.30, 31 Two trials were excluded because the abstracts did not provide enough

Discussion

Radial access reduced the odds of major bleeding by 73% in patients undergoing coronary angiography or intervention compared to femoral access. There was a trend toward reduction in the composite of death, MI, or stroke comparing radial vs. femoral access but, because of low event rates, lacked statistical power. The point estimate suggests a possible clinically relevant 30% reduction in cardiovascular events, emphasizing the need for adequately powered randomized trials.

These findings differ

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