Radial vs. Femoral Access in Women | Journal Scan

Study Questions:

What is the safety and efficacy of radial versus femoral access in women undergoing coronary angiography/intervention?


The authors reported a subanalysis of the RIVAL (RadIal Vs femorAL access for coronary intervention) trial in which they compared outcomes in women (n = 1,861) and men (n = 5,160) randomized to radial versus femoral access.


The rate of vascular complications in women was higher compared with men (4.7% vs. 1.7%; p < 0.0001). Major vascular complications were significantly reduced with radial access in women (3.1% vs. 6.1%, p = 0.002) as well as in men (0.7% vs. 2.8%; p < 0.0001). Crossover rates with radial access were higher in women compared with men (11.1% vs. 6.3%), and this difference was driven in large part by greater likelihood of radial artery spasm and radial loops in women. In multivariable analyses, female sex was an independent predictor of major vascular complications (hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.76-3.25; p < 0.0001). Percutaneous coronary intervention (PCI) success rates with both radial and femoral access were similar in men and women, with no differences in PCI complications. There was no difference for the primary composite endpoint of death, myocardial infarction, stroke, and non-coronary artery bypass grafting bleeding between the two access strategies for both women (3.9% vs. 5.0%; HR, 0.77; 95% CI, 0.50-1.19) and men ( 3.54% vs. 3.5%; HR, 1.00; 95% CI, 0.75 to -1.34).


Radial access is associated with a reduction in vascular complications, with the absolute reduction being greater in women compared with men.


The rates of vascular complications among patients undergoing transfemoral catheterization have come down in recent years with meticulous attention to access and vascular closure, but radial access remains the most effective strategy at reducing vascular access complications. This trial demonstrates that women, despite having a higher crossover rate, appear to derive enhanced benefit from radial access, and the radial approach should be preferentially used in both men and women.

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

Keywords: Acute Coronary Syndrome, Catheterization, Coronary Angiography, Coronary Artery Bypass, Female, Femoral Artery, Hemorrhage, Mortality, Myocardial Infarction, Percutaneous Coronary Intervention, Radial Artery, Spasm, Stroke

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