CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures
Systematic overview and meta-analysis of randomized trials
Pierfrancesco Agostoni, MD*,*,
Giuseppe G. L. Biondi-Zoccai, MD ,
M. Luisa De Benedictis, MD*,
Stefano Rigattieri, MD,
Marco Turri, MD*,
Maurizio Anselmi, MD*,
Corrado Vassanelli, MD ,
Piero Zardini, MD*,
Yves Louvard, MD and
Martial Hamon, MD||
* Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Verona, Italy
Institute of Cardiology, Catholic University, Rome, Italy
Institute of Cardiology, Piemonte Orientale University, Novara, Italy
Institut Hospitalier Jacques Cartier—ICPS, Massy, France
|| Service des Maladies du Coeur et Vaisseaux, Centre Hospitalier Universitaire, Caen, France
Manuscript received February 9, 2004;
revised manuscript received March 17, 2004,
accepted April 6, 2004.
* Reprint requests and correspondence: Dr. Pierfrancesco Agostoni, Catheterization Laboratory, Section of Cardiology, Department of Biomedical and Surgical Sciences, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy.
agostonipf{at}genie.it
This study was presented as an abstract at the 2003 Congress of the Italian Society of Invasive Cardiology, Genoa, Italy, October 15–18, 2003.
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.
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Abbreviations and Acronyms
| | 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 |
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