1. In this systematic review and meta-analysis, radial percutaneous access during invasive management of acute coronary syndrome was associated with decreased mortality, major adverse coronary events, and major bleeding when compared to femoral access.
2. However, radial artery access was associated with higher cross-over to femoral access.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Early invasive treatment of acute coronary syndrome (ACS; a group of diseases including heart attacks) frequently relies upon insertion of a catheter through blood vessels to relieve blockages in arteries supplying the heart. Typically, the catheter is inserted either through a major artery in the leg (i.e., the femoral artery) or arm (i.e., the radial artery) to access the heart’s blood supply. However, there is conflicting evidence about safety and efficacy of femoral vs. radial artery access. Therefore, this study analyzed data from four major trials that compared femoral vs. radial access in catheter-based management of ACS. Overall, compared to femoral access, radial access was associated with significantly decreased risk of death, major negative cardiac events, and major bleeding in the 30 days following the procedure. Notably, procedures using radial artery access took marginally longer than procedures using the femoral artery; procedures that began with radial access more frequently required conversion to femoral-based procedures than vice versa, although rates of conversion were low. Although the included studies required minimum levels of proficiency to complete the procedures, provider experience and expertise with femoral vs. radial access may have impacted results, which may impact the generalizability of this analysis to clinical care. Nevertheless, these results provide compelling evidence that radial access may be safer than femoral access for catheter-based treatment of ACS.
In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis pooled data from 17 133 patients enrolled in four large, high-quality, randomized clinical trials evaluating radial vs. femoral access for cardiac catheterization during ACS. Patients were followed for 30 days post-procedure. Overall, radial access was associated with decreased risk of all-cause mortality (relative risk 0.73, 95%CI 0.59 – 0.90, I2 0%), major adverse cardiac events (RR 0.86, 95%CI 0.75 – 0.98, I2 11%), access-site bleeding (RR 0.36, 95%CI 0.28 – 0.47, I2 0%), and major bleeding (RR 0.57, 95% 0.37 – 0.88, I2 52%). There was a 6.3% rate of crossover from radial to femoral access, compared to a 1.7% of crossover from femoral to radial access, although there was a high degree of heterogeneity between studies for this outcome (I2 88%). Notably, of the four trials included, only two included patients with non-ST elevation myocardial infarcts (NSTEMI).
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