title: Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  This study sought to determine the safety and efficacy of radial access compared with femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Numerous randomized controlled trials, including several new studies, have compared outcomes of these approaches in the context of primary PCI for STEMI patients with inconclusive results.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials to compare outcomes in STEMI patients undergoing radial versus femoral access for primary PCI. Primary outcomes were death and major bleeding evaluated at the longest available follow-up. Secondary outcomes included access site bleeding, stroke, and procedure time. Twelve studies (N = 5,055) were included. All trials were conducted in centers experienced with both approaches.
  
  
  RESULTS
  Compared with femoral approach, radial approach was associated with decreased risk of mortality (2.7% vs. 4.7%; odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.40 to 0.76; p < 0.001) and decreased risk of major bleeding (1.4% vs. 2.9%; OR: 0.51, 95% CI: 0.31 to 0.85; p = 0.01). Radial access was also associated with reduction in relative risk of access site bleeding (2.1% vs. 5.6%; OR: 0.35, 95% CI: 0.25 to 0.50; p < 0.001). Stroke risk was similar between both approaches (0.5% vs. 0.5%; OR: 1.07, 95% CI: 0.45 to 2.54; p = 0.87). The procedure time was slightly longer in the radial group than in the femoral group (mean difference: 1.52 min; 95% CI: 0.33 to 2.70, p = 0.01).
  
  
  CONCLUSIONS
  In STEMI patients undergoing primary PCI, the radial approach is associated with favorable outcomes and should be the preferred approach for experienced radial operators.
authors: Department of Cardiovascular Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA. wassef@hotmail.com
authors: Wassef
authors: W
authors: Karrowni
authors: Ankur
authors: A
authors: Vyas
authors: Bria
authors: B
authors: Giacomino
authors: Marin
authors: M
authors: Schweizer
authors: Amy
authors: A
authors: Blevins
authors: Saket
authors: S
authors: Girotra
authors: Phillip A
authors: PA
authors: Horwitz
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: CI; MACE; MI; OR; PCI; ST-segment elevation myocardial infarction; STEMI; TIMI; TLR; TVR; Thrombolysis In Myocardial Infarction; confidence interval(s); major cardiovascular adverse events; meta-analysis; myocardial infarction; odds ratio; percutaneous coronary intervention; primary percutaneous coronary intervention; radial access; target lesion revascularization; target vessel revascularization