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Femoral access is the most commonly used vascular access approach for coronary angiography and percutaneous coronary intervention (PCI), but carries a risk of bleeding and vascular complications, which have been associated with a higher risk of major adverse cardiovascular events (MACE). The use of the radial access has been reported to reduce bleeding and vascular complications linked with these procedures, but it is unknown whether this reduction translates into a decreased incidence of MACE. We performed a systematic review and meta–analysis to compare radial access to femoral access with regards to MACE and bleeding complications.
Database searches of MEDLINE, EMBASE, CENTRAL, and LILACS as well as major conference abstracts were performed using a highly sensitive search strategy. Randomized studies of adults referred for coronary angiography and/or PCI for known or suspected CAD comparing radial to femoral access published from 1/1/1985 to 9/12/2012 were included. We qualitatively evaluated study methodology and risk of bias. Quantitative data were abstracted relevant to the primary endpoints of MACE (death, MI, or stroke) and major bleeding, and secondary outcomes including vascular complications, access site cross–over, and procedural failure.
We identified 5,092 relevant titles, from which 25 studies encompassing 14,386 patients contributed to the analysis. Most of the included studies enrolled fewer than 600 patients. There was significant reduction in bleeding events and vascular complications with radial access (RR 0.52, 95% CI 0.37 to 0.73, I2 = 0; and RR 0.36, 95% CI 0.23 to 0.55, I2 = 69%; respectively), while access site cross–over and procedure failure were more common with radial access (RR 3.21, 95% CI 2.11 to 4.88, I2 = 28%; and RR 1.57, 95% CI 1.05 to 2.04, I2 = 40%; respectively). Despite the reduction in bleeding and vascular complications, there was no significant difference in the composite of death, MI, or stroke between radial and femoral access (RR 0.92, 95% CI 0.76 to 1.12, I2 = 0).
Radial access reduces the risk of major bleeding and vascular complications as compared to femoral access, but this does not yield a reduction in MACE.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Radial Access
Abstract Category: 53. TCT@ACC–i2: Vascular Access and Closure Devices and Complications
Presentation Number: 2102–260
- 2013 American College of Cardiology Foundation