Abstract 17848: Influence of Radial versus Femoral Access Site on Outcomes Following Coronary Angiography and Intervention: A Systemic Review and Meta-Analysis
Introduction: The radial approach (RA) has decreased bleeding complications and major adverse cardiovascular events (MACE) as compared to the femoral approach (FA) in several large investigations. We performed a systematic review and meta-analysis of randomized trials comparing RA vs. FA for coronary angiography (CA) and percutaneous coronary intervention (PCI).
Methods: Searches of MEDLINE, EMBASE, CENTRAL, LILACS, and major conference abstracts identified relevant studies published from January 1, 1985 to January 1, 2016. We qualitatively evaluated study methodology and risk of bias. Quantitative data were abstracted relevant to the primary endpoints of MACE (death, myocardial infarction [MI], or stroke) and major bleeding (by modified OASIS and BARC criteria), as well as secondary outcomes including vascular complications and procedural failure.
Results: We identified 2,098 relevant titles, from which 52 studies with 27,784 patients contributed to the final analysis. Most studies (65%) enrolled fewer than 300 patients, and only 6 studies enrolled more than 1,000 patients. There was a significant reduction in the composite endpoint of death, MI, or stroke with RA vs. FA (risk ratio [RR] 0.86, 95% confidence interval [CI] 0.77-0.95, I2 = 0%) that was driven by a reduction in death (RR 0.73, 95% CI 0.60-0.89, I2 = 0%), but not MI (RR 0.92, 95% CI 0.81-1.04, I2 = 0%) or stroke (RR 1.06, 95% CI 0.70-1.61, I2 = 0%). Major bleeding occurred less frequently with RA (RR 0.55, 95% CI 0.45-0.67, I2 = 1%). Vascular complications were also reduced (RR 0.38, 95% CI 0.25-0.57, I2 = 74%), while procedure failure was more common with RA (RR 1.94, 95% CI 1.43-2.59, I2 = 62%), although there was significant statistical heterogeneity for both outcomes. Most studies demonstrated low risk of selection and attrition biases, but high risk for detection bias.
Conclusions: The radial approach to CA and PCI reduces the risk of death, major bleeding, and vascular complications as compared to the femoral approach, but increases the risk of procedural failure.
Author Disclosures: M. Brener: None. A. Bush: None. R.K. Hasan: None.
- © 2016 by American Heart Association, Inc.