title: Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials.
abstract: The aim of this study was to provide a quantitative appraisal of the effects on clinical outcomes of radial access for coronary interventions in patients with coronary artery disease (CAD).
  
  
  
  Randomized trials investigating radial versus femoral access for percutaneous coronary interventions have provided conflicting evidence. No comprehensive quantitative appraisal of the risks and benefits of each approach is available across the whole spectrum of patients with stable or unstable CAD.
  
  
  
  The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized trials comparing radial versus femoral access for coronary interventions. Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Pre-specified subgroup analyses according to clinical presentation, in terms of stable CAD, non-ST-segment elevation acute coronary syndromes, or ST-segment elevation myocardial infarction were performed.
  
  
  
  Twenty-four studies enrolling 22,843 participants were included. Compared with femoral access, radial access was associated with a significantly lower risk for all-cause mortality (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.87; p = 0.001, number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR: 0.84; 95% CI: 0.75 to 0.94; p = 0.002; NNTB = 99), major bleeding (OR: 0.53; 95% CI: 0.42 to 0.65; p < 0.001; NNTB = 103), and major vascular complications (OR: 0.23; 95% CI: 0.16 to 0.35; p < 0.001; NNTB = 117). The rates of myocardial infarction or stroke were similar in the 2 groups. Effects of radial access were consistent across the whole spectrum of patients with CAD for all appraised endpoints.
  
  
  
  Compared with femoral access, radial access reduces mortality and MACE and improves safety, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy. Electronic address: giu.ferrante@hotmail.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Applied Health Research Centre The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.affiliation: Institute of Primary Health Care, University of Bern, Bern, Switzerland.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Da Costa
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Rozzano, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Condorelli
authors.affiliation: Department of Interventional Cardiology, Humanitas Mater Domini, Castellanza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Anzuini
authors.affiliation: McMaster University and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
authors.affiliation: Interventional Cardiology, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. Electronic address: marco.valgimigli@insel.ch.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D019317:Evidence-Based Medicine; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017534:Radial Artery / Q000000981:diagnostic imaging; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: bleeding; femoral access; percutaneous coronary intervention; radial access; vascular complications