Background: Substantial improvements have been achieved with percutaneous coronary
intervention (PCI) for the treatment of Acute Coronary Syndromes (ACS). Nevertheless, bleeding still
affects outcomes. The radial approach for PCI has shown important benefits on access site complications,
but is still not achieving universal consensus as first choice in acute settings. Therefore, we performed
a comprehensive meta-analysis of randomized trials comparing radial vs femoral approach in
PCI for ACS.
Methods: The literature and main scientific session abstracts were scanned for randomized studies comparing
radial vs femoral approach for PCI in ACS. Primary endpoint was mortality within 30-days. Secondary
endpoints were: 1) Major Adverse Cardiovascular Events (MACE), 2) major bleeding, and, 3)
Results: We included 17 randomized trials, enrolling 19325 patients. A total of 9635 patients were randomized
to the radial approach and 9690 to the femoral approach. The radial approach was associated
with a significant reduction in mortality (1.8 vs 2.5%, odds ratio, OR [95% CI] = 0.72 [0.59,0.88], p =
0.001, pheterogeneity = 0.31) and in major bleeding complications compared with the femoral approach (1.5
vs 2.6%, OR [95% CI] = 0.57 [0.47, 0.71], p < 0.00001, pheterogeneity = 0.59), with similar advantages
observed for both ST-elevation myocardial infarction and non-ST segment elevation ACS. MACE occurrence
and vascular complications were also reduced with the radial approach (OR [95% CI] = 0.82
[0.74, 0.92], p = 0.0005, and OR [95% CI] = 0.52 [0.47, 0.58], p < 0.00001, respectively). Our results
were not influenced by patient risk profile or the antithrombotic strategy applied.
Conclusion: Our meta-analysis shows that among ACS patients undergoing PCI, the radial approach is
associated with a significant reduction in mortality, major bleeding complications, MACE and vascular
complication compared with the femoral approach.