Original Title: Radial vs femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials.
Reference: Ferrante G et al. J Am Coll Cardiol Intv. 2016; Epub ahead of print.
Regardless the type of coronary syndrome, the transradial approach results in lower mortality and complications compared to the femoral.
Some studies (especially on chronic and stable patients) have seen contradicting results as regards the advantages of the transradial approach over the femoral, which is why this meta-analyzis of 24 studies was carried out, involving over 22,843 patients with PCI in the context of ACS
- without ST elevation
- with ST elevation
- in stable patients
The transradial approach showed lower risk of all cause death (OR 0.71, CI 95% 0.58 to 0.87) and lower risk of combined cardiovascular events (OR 0.84; CI 95% 0.75 to 0.94) in the general population.
The transradial approach was also associated to lower major bleeding rate (OR 0.53; CI 95% 0.42 to 0.65) and lower major vascular complications rate (OR 0.23; CI 95% 0.16 to 0.34).
Other important data resulting from this work is that MI and stroke rates resulted similar for both vascular access sites.
When analyzing outcomes according to clinical presentation, stable patients are those who benefit most from reduced major bleeding. In the group of ACS patients, ST elevation MI patients saw the greatest benefit with transradial approach.
Lastly, the experienced centers obtained the highest benefits vs. femoral approach.
Conclusion
The transradial approach reduces mortality and combined events, and improves safety because of reduced bleeding and vascular complications, compared to the femoral access.
Editorial Comment
The benefit of the transradial approach seems out of question; however, a great randomized study would be useful to understand the mechanisms behind this advantage. Reduced major bleeding seems to be the main reason behind mortality decrease, though it may not be enough: there may be other, hidden mechanisms involved.
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