Radial Versus Femoral Access in Invasively Managed Patients With Acute Coronary Syndrome: Systematic Review and Meta-analysis

Background: Studies in patients with acute coronary syndrome (ACS) undergoing invasive management showed conflicting conclusions regarding the effect of access site on outcomes. Purpose: To summarize evidence from recent, high-quality trials that compared clinical outcomes occurring with radial versus femoral access in invasively managed adults with ACS. Data Sources: English-language publications in MEDLINE, EMBASE, and Cochrane databases between January 1990 and August 2015. Study Selection: Randomized trials of radial versus femoral access in invasively managed patients with ACS. Data Extraction: Two investigators independently extracted the study data and rated the risk of bias. Data Synthesis: Of 17 identified randomized trials, 4 were high-quality multicenter trials that in total involved 17 133 patients. Pooled data from the 4 trials showed that radial access reduced death (relative risk [RR], 0.73 [95% CI, 0.59 to 0.90]; P = 0.003), major adverse coronary events (RR, 0.86 [CI, 0.75 to 0.98]; P = 0.025), and major bleeding (RR, 0.57 [CI, 0.37 to 0.88]; P = 0.011). Radial procedures lasted slightly longer (standardized mean difference, 0.11 minute) and had higher risk for access-site crossover (6.3% versus 1.7%) than did femoral procedures. Limitations: Heterogeneity in outcomes definitions and potential treatment modifiers across studies, including operator experience in radial procedures and concurrent anticoagulant regimens. Conclusions: Compared with femoral access, radial access reduces mortality, major coronary adverse events, and major bleeding in patients with ACS undergoing invasive management. Primary funding sources: No external funding. (PROSPERO: CRD42015022031)