Transradial access (TRA) in patients undergoing coronary angiography with or without PCI significantly reduced the risk of mortality and major bleeding at 30 days compared with transfemoral access (TFA), based on findings from a large meta-analysis of individual patient data from seven randomized clinical trials presented Aug. 29 as part of ESC Congress 2022 in Barcelona, and simultaneously published in Circulation.

Researchers analyzed data from a total of 21,600 patients, of whom 10,775 underwent TRA and 10,825 underwent TFA. The median age was approximately 64 years, nearly 32% were female, and 75% underwent PCI. The primary outcomes were all-cause mortality and major bleeding at 30 days. Multivariable analysis was used to further assess the impact of access-site on mortality and major bleeding.

Overall results found all-cause mortality was lower in the TRA group (1.6%) compared with the TFA group (2.1%), as was major bleeding (1.5% vs. 2.7%). Researchers noted that subgroup analyses for mortality showed "consistent results," with the exception of baseline hemoglobin (p interaction=0.033). This suggests "that the benefit of TRA was substantial in patients with significant anemia, while it was not significant in patients with milder or no baseline anemia," researchers said. Additionally, a mediation analysis showed that "the benefit of TRA on mortality was only partially driven by major bleeding prevention, and ancillary mechanisms are required to fully explain the causal association."

Based on the evidence, Giuseppe Gargiulo, MD, PhD, and colleagues said "TRA should be considered the preferable access-site for percutaneous coronary procedures in patients with [acute coronary syndromes] supporting most recent recommendations on the preferential use of radial approach."

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC Congress, ESC22, ACC International, Percutaneous Coronary Intervention, Acute Coronary Syndrome, Coronary Angiography, Mediation Analysis, Hemorrhage, Anemia

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