Radial vs. Femoral Access in Acute Coronary Syndrome

Study Questions:

What is the clinical impact of using radial access versus femoral access in invasively managed adults with acute coronary syndromes (ACS)?


The authors performed a meta-analysis and a systematic review of randomized controlled trials that compared radial versus femoral access in patients with ACS.


The authors identified 17 randomized trials, of which four were high-quality multicenter trials. Pooled data from these four trials (n = 17,133) showed that radial access was associated with a reduced risk of death (relative risk [RR], 0.73; 95% confidence interval [CI], 0.59-0.90; p = 0.003), major adverse cardiovascular events (RR, 0.86; CI, 0.75-0.98; p = 0.025), and major bleeding (RR, 0.57; CI, 0.37-0.88; p = 0.011). The radial approach was associated with a slightly longer procedure duration (standardized mean difference, 0.11 minutes) and had higher risk for access-site crossover (6.3% vs. 1.7%) than did femoral procedures.


The authors concluded that radial access is associated with reduction in bleeding and mortality among patients with ACS.


This meta-analysis adds to the growing body of data demonstrating the benefits of the radial approach. The strong reduction in bleeding and mortality demonstrated in this study suggests that radial access should be the preferred approach for ACS patients treated with an invasive approach.

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