title: Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome.
abstract: OBJECTIVE
  Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are needed. This systematic review and meta-analysis aims to compare major cardiovascular outcomes and safety endpoints in patients with ACS managed with PCI using radial versus femoral access.
  
  
  METHODS
  Randomized controlled trials and cohort studies comparing RA versus FA in patients with ACS were analyzed. Our primary outcomes were mortality, major adverse cardiac event, major bleeding, and access-related complications. A fixed-effects model was used for the primary analyses.
  
  
  RESULTS
  Fifteen randomized controlled trials and 17 cohort studies involving 44,854 patients with ACS were identified. Compared with FA, RA was associated with a reduction in major bleeding (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.33-0.61, P < 0.001), access-related complications (OR 0.27, 95% CI 0.18-0.39, P < 0.001), mortality (OR 0.64, 95% CI 0.54-0.75, P < 0.001), and major adverse cardiac event (OR 0.70, 95% CI 0.57-0.85, P < 0.001). These significant reductions were consistent across different study designs and clinical presentations.
  
  
  CONCLUSIONS
  Based on this large meta-analysis, RA for primary PCI in the setting of ACS is associated with reduction in cardiac and safety endpoints when compared with FA in both urgent and elective procedures. This should encourage a wider adoption of this technique among centers and interventional cardiologists.
authors.affiliation: From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ruiz-Rodriguez
authors.affiliation: From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Asfour
authors.affiliation: From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky.
authors.forename: Georges
authors.initials: G
authors.lastname: Lolay
authors.affiliation: From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Ziada
authors.affiliation: From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky.
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Abdel-Latif
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery / Q000601:surgery*; D016896:Treatment Outcome