Radial access for coronary interventions leads to lower risk for all-cause mortality
A meta-analysis of randomized clinical trials found that radial access for coronary interventions in patients with coronary artery disease was associated with a significantly lower risk for all-cause mortality and major adverse cardiovascular events compared with femoral access.
Radial access was also associated with a significantly lower risk for major bleeding and major vascular complications. However, patients in both groups had similar rates of MI and stroke.
Lead researcher Giuseppe Ferrante, MD, PhD, of Humanitas Research Hospital and Humanitas Clinical and Research Center in Rozzano, Italy, and colleagues published their results July 25 in the Journal of the American College of Cardiology: Cardiovascular Interventions.
“These findings support the use of radial access as the default approach for coronary angiography followed by PCI in the whole spectrum of patients with [coronary artery disease] undergoing invasive management and strongly support a change in the “femoral first” paradigm to a “radial first” approach,” the researchers wrote.
The researchers searched the MEDLINE, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases from inception to January 2016. They also searched conference proceedings from 2010 through December 2015 of the American Heart Association, American College of Cardiology, Transcatheter Cardiovascular Therapeutics and European Society of Cardiology.
They identified 24 studies that met their inclusion criteria, which included a randomized design that compared radial versus femoral access for coronary interventions and had more than 50 percent of patients undergoing coronary angiography followed by PCI. The trials enrolled a total of 22,843 patients.
The analysis showed that radial access was associated with a 29 percent relative risk reduction for all-cause mortality and a 16 percent relative risk reduction of major adverse cardiovascular events. Most studies defined major adverse cardiovascular events as the composite of death, stroke and MI.
The radial approach was also associated with a 47 percent relative risk reduction for major bleeding and a 77 percent relative risk reduction for major vascular complications.
The researchers performed a Bayesian analysis that found the level of evidence for the radial access’s beneficial effect was strong to very strong for major bleeding and major vascular complications, moderate to strong for all-cause mortality and moderate for major adverse cardiovascular events.
In addition, radial access was beneficial in several subgroups and was mostly consistent across stable or unstable presentation and the type of acute coronary syndromes, according to the researchers.
They also cited a few limitations of the study, including that they detected significant heterogeneity and bias in net adverse clinical events. The studies had different classifications for bleeding complications, as well. In addition, there was a high risk of bias in most studies, and the differences in absolute event rates between groups were small for several endpoints.
“The mechanisms by which radial access is associated with reduced all-cause mortality compared with femoral access, specifically whether this involves a reduction in the risk for major bleeding, require additional studies,” the researchers wrote.
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.