Study Supports Radial Access Versus Femoral Access for Coronary Interventions

July 28, 2016—A meta-analysis of randomized trials that sought to provide a quantitative appraisal of the effects on clinical outcomes of radial access for coronary interventions in patients with coronary artery disease (CAD) was published by Giuseppe Ferrante, MD, et al in the Journal of American College of Cardiology (JACC): Cardiovascular Interventions (2016;9:1419–1434).

The investigators concluded that compared with femoral access, radial access reduces mortality and major adverse cardiac events and improves safety, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.

According to the investigators, randomized trials investigating radial versus femoral access for percutaneous coronary interventions have provided conflicting evidence. Additionally, 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.

As summarized in JACC: Cardiovascular Interventions, the investigators searched the PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for randomized trials comparing radial versus femoral access for coronary interventions. The study was composed of 24 studies enrolling 22,843 participants.

Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Prespecified subgroup analyses were performed according to clinical presentation, in terms of stable CAD, non–ST-segment elevation acute coronary syndromes, or ST-segment elevation myocardial infarction.

The investigators found that radial access versus femoral 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 = .001; number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR, 0.84; 95% CI, 0.75 to 0.94; P = .002; NNTB = 99), major bleeding (OR, 0.53; 95% CI, 0.42 to 0.65; P < .001; NNTB = 103), and major vascular complications (OR, 0.23; 95% CI, 0.16 to 0.35; P < .001; NNTB = 117). The rates of myocardial infarction or stroke were similar in the two groups. Effects of radial access were consistent across the whole spectrum of patients with CAD for all appraised endpoints, reported the investigators in JACC: Cardiovascular Interventions.