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 involved a total of 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 cardiovascular 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 minutes) and had higher risk for access-site crossover (6.3% vs. 1.7%) than did femoral procedures. LIMITATION: Heterogeneity in outcomes definitions and potential treatment modifiers across studies, including operator experience in radial procedures and concurrent anticoagulant regimens. CONCLUSION: Compared with femoral access, radial access reduces mortality, major adverse cardiovascular events, and major bleeding in patients with ACS undergoing invasive management. PRIMARY FUNDING SOURCE: None. (PROSPERO registration number: CRD42015022031).
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 involved a total of 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 cardiovascular 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 minutes) and had higher risk for access-site crossover (6.3% vs. 1.7%) than did femoral procedures. LIMITATION: Heterogeneity in outcomes definitions and potential treatment modifiers across studies, including operator experience in radial procedures and concurrent anticoagulant regimens. CONCLUSION: Compared with femoral access, radial access reduces mortality, major adverse cardiovascular events, and major bleeding in patients with ACS undergoing invasive management. PRIMARY FUNDING SOURCE: None. (PROSPERO registration number: CRD42015022031).
Authors: Davide Capodanno; Deepak L Bhatt; C Michael Gibson; Stefan James; Takeshi Kimura; Roxana Mehran; Sunil V Rao; Philippe Gabriel Steg; Philip Urban; Marco Valgimigli; Stephan Windecker; Dominick J Angiolillo Journal: Nat Rev Cardiol Date: 2021-08-23 Impact factor: 32.419
Authors: Ahmed A Kolkailah; Rabah S Alreshq; Ahmed M Muhammed; Mohamed E Zahran; Marwah Anas El-Wegoud; Ashraf F Nabhan Journal: Cochrane Database Syst Rev Date: 2018-04-18
Authors: Omaditya Khanna; Nikolaos Mouchtouris; Ahmad Sweid; Nohra Chalouhi; Ritam Ghosh; Fadi Al Saiegh; Michael R Gooch; Stavropoula Tjoumakaris; Robert H Rosenwasser; Victor Romo; Pascal Jabbour Journal: Stroke Vasc Neurol Date: 2019-11-27