Objectives: Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) inwhomaggressive anticoagulation and platelet inhibition regimens are needed. This systematic review and metaanalysis aims to compare major cardiovascular outcomes and safety endpoints in patients with ACS managed with PCI using radial versus femoral access. Methods: Randomized controlled trials and cohort studies comparing RA versus FA in patients with ACS were analyzed. Our primary outcomes were mortality, major adverse cardiac event, major bleeding, and access-related complications. A fixed-effects model was used for the primary analyses. Results: Fifteen randomized controlled trials and 17 cohort studies involving 44,854 patients with ACS were identified. Compared with FA, RAwas associated with a reduction in major bleeding (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.33Y0.61, P G 0.001), access-related complications (OR 0.27, 95% CI 0.18Y0.39, P G 0.001), mortality (OR 0.64, 95%CI 0.54Y0.75, P G 0.001), and major adverse cardiac event (OR 0.70, 95% CI 0.57Y0.85, P G 0.001). These significant reductions were consistent across different study designs and clinical presentations. Conclusions: Based on this large meta-analysis, RA for primary PCI in the setting of ACS is associated with reduction in cardiac and safety endpoints when compared with FA in both urgent and elective procedures. This should encourage a wider adoption of this technique among centers and interventional cardiologists.
Bibliographical noteFunding Information:
A.K.A. is supported by University of Kentucky Clinical and Translational Science Pilot Award (UL1TR000117), the UK COBRE Early Career Program (P20 GM103527), and National Institutes of Health Grant no. R56 HL124266. K.M.Z. has received compensation for educational training. The remaining authors have no financial relationships to disclose and no conflicts of interest to report.
- acute coronary syndrome
- femoral artery access
- percutaneous coronary interventions
- radial artery access