Clinical research: interventional cardiology
Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and meta-analysis of randomized trials

This study was presented as an abstract at the 2003 Congress of the Italian Society of Invasive Cardiology, Genoa, Italy, October 15–18, 2003.
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Abstract

Objectives

We sought to compare, through a meta-analytic process, the transradial and transfemoral approaches for coronary procedures in terms of clinical and procedural outcomes.

Background

The radial approach has been increasingly used as an alternative to femoral access. Several trials have compared these two approaches, with inconclusive results.

Methods

The MEDLINE, CENTRAL, and conference proceedings from major cardiologic associations were searched. Random-effect odds ratios (ORs) for failure of the procedure (crossover to different entry site or impossibility to perform the planned procedure), entry site complications (major hematoma, vascular surgery, or arteriovenous fistula), and major adverse cardiovascular events (MACE), defined as death, myocardial infarction, emergency revascularization, or stroke, were computed.

Results

Twelve randomized trials (n = 3,224) were included in the analysis. The risk of MACE was similar for the radial versus femoral approach (OR 0.92, 95% confidence interval [CI] 0.57 to 1.48; p = 0.7). Instead, radial access was associated with a significantly lower rate of entry site complications (OR 0.20, 95% CI 0.09 to 0.42; p < 0.0001), even if at the price of a higher rate of procedural failure (OR 3.30, 95% CI 1.63 to 6.71; p < 0.001).

Conclusions

The radial approach for coronary procedures appears as a safe alternative to femoral access. Moreover, radial access virtually eliminates local vascular complications, thanks to a time-sparing hemostasis technique. However, gaining radial access requires higher technical skills, thus yielding an overall lower success rate. Nonetheless, a clear ongoing trend toward equalization of the two procedures, in terms of procedural success, is evident through the years, probably due to technologic progress of materials and increased operator experience.

Abbreviations

CABG
coronary artery bypass graft surgery
CI
confidence interval
MACE
major adverse cardiovascular events
OR
odds ratio
PCI
percutaneous coronary procedure
PTCA
percutaneous transluminal coronary angioplasty
SMD
standardized mean difference
WMD
weighted mean difference

Cited by (0)

This meta-analysis is part of an ongoing training project of the Center for Overview, Meta-analysis and Evidence-based medicine Training (COMET), based in Verona, Italy.