Abstract 9966: Radial versus Femoral Access in Acute Coronary Syndrome: Decrease in Mortality, Major Adverse Cardiac Events and Bleeding - An Updated Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Previous studies have come to inconsistent results about the role of radial access in reducing adverse outcomes in patients with Acute Coronary Syndrome (ACS) undergoing coronary angiography or Percutaneous Coronary Intervention (PCI). A meta-analysis was performed to summarize the up-to-date evidence on this subject. Methods: The Pubmed, EMBASE, Scopus and ClinicalTrials.gov databases were searched from inception to April 2015. The results was limited to Randomized Controlled Trials (RCTs) that evaluated the outcomes in patients with ACS undergoing radial versus femoral access for coronary angiography or PCI. Only studies that reported clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included Non-CABG major bleeds, Major Adverse Cardiac Events (MACE: Composite of death, myocardial infarction, or stroke), recurrent myocardial infarction (MI) and stroke. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all the clinical outcomes. Results: Sixteen RCT’s (n = 18,947) fulfilled the inclusion criteria. A total of 9,454 (49.9%) subjects were randomized to radial access and 9,493 (50.1%) to femoral access. The allocation to the radial approach was associated with decrease risk of all-cause mortality (1.7% vs. 2.4%; RR 0.72; 95% CI 0.59-0.88; I2 = 0%; P = 0.0010), decrease in non-CABG major bleeding (1.2% vs. 2.2%; RR 0.60; 95% CI 0.48-0.76; I2 = 0%; P < 0.0001), and decrease in MACE (6.2% vs. 7.2%; RR 0.85; 95% CI 0.77-0.95; I2 = 0%; P = 0.004). The rate of recurrent MI (4.0% vs. 4.4%; RR 0.91; 95% CI 0.80-1.04; I2 = 0%; P = 0.18) and stroke was similar with both approaches (0.49% vs. 0.41%; RR 1.19; 95% CI 0.77-1.84; I2 = 0%; P = 0.42). Conclusions: The current meta-analysis shows that radial access in patients with ACS undergoing coronary angiography or PCI reduces all-cause mortality, major bleeds and MACE. No substantial difference was found in the rate of recurrent MI or stroke.