Radial Access Reduces Mortality in Acute Coronary Syndromes
What is the impact of radial access as a bleeding avoidance strategy on mortality and ischemic endpoints in patients with acute coronary syndromes (ACS)?
English-language publications and abstracts of major cardiovascular meetings until October 2015 were scrutinized. Study quality, patient characteristics, procedural data, and outcomes were extracted. Data were pooled in random-effects meta-analyses with classic and trial sequential techniques. Trial sequential analysis combines the a priori information size calculation needed to allow for clinically meaningful statistical inference with the adjustment of thresholds for which results are considered significant.
Seventeen studies, encompassing data from 19,328 patients, were pooled. Radial access was found to reduce mortality (relative risk [RR], 0.73; 95% confidence interval [CI], 0.60-0.88; p = 0.001), major adverse cardiovascular events (MACE) (RR, 0.86; 95% CI, 0.77-0.95; p = 0.005), and major bleeding (RR, 0.60; 95% CI, 0.48-0.76; p < 0.001). Multiple sensitivity analyses showed consistent results, and trial sequential analysis suggested firm evidence for a significant reduction in mortality with radial access.
The authors concluded that radial access reduces mortality compared with femoral access in ACS patients undergoing invasive management.
This study reports that radial access was shown to significantly reduce mortality, MACE, access site bleeding, and major bleeding, with no significant effects noted on recurrent myocardial infarction and stroke. The analysis also suggests that the benefit of radial access may be larger, but not confined to cases performed by expert or high-volume operators. It stands to reason that the radial artery should be the vascular access of choice for experienced centers treating patients with ACS, and that femoral-oriented centers should consider a transition to the radial approach. At the same time, it is important that we do not lose the skills for femoral access, as some patients may require this approach for catheterization.
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