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 CartierICPS, 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 1518, 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.
|
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 |
|
This article has been cited by other articles:

|
 |

|
 |
 
M. Brueck, D. Bandorski, W. Kramer, M. Wieczorek, R. Holtgen, and H. Tillmanns
A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty
J. Am. Coll. Cardiol. Intv.,
November 1, 2009;
2(11):
1047 - 1054.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Dehghani, A. Mohammad, R. Bajaj, T. Hong, C. M. Suen, W. Sharieff, R. J. Chisholm, M. J.B. Kutryk, N. P. Fam, and A. N. Cheema
Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventions
J. Am. Coll. Cardiol. Intv.,
November 1, 2009;
2(11):
1057 - 1064.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Heiss, J. Balzer, T. Hauffe, S. Hamada, E. Stegemann, T. Koeppel, M. W. Merx, T. Rassaf, M. Kelm, and T. Lauer
Vascular Dysfunction of Brachial Artery After Transradial Access for Coronary Catheterization: Impact of Smoking and Catheter Changes
J. Am. Coll. Cardiol. Intv.,
November 1, 2009;
2(11):
1067 - 1073.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J.-P. Bassand, R. Afzal, J. Eikelboom, L. Wallentin, R. Peters, A. Budaj, K. A.A. Fox, C. D. Joyner, S. Chrolavicius, C. B. Granger, et al.
Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes
Eur. Heart J.,
October 12, 2009;
(2009)
ehp401v1.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S L Hetherington, Z Adam, R Morley, M A de Belder, J A Hall, D F Muir, A G C Sutton, N Swanson, and R A Wright
Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: changing patterns of vascular access, radial versus femoral artery
Heart,
October 1, 2009;
95(19):
1612 - 1618.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H. Gouya, O. Varenne, L. Trinquart, E. Touze, O. Vignaux, C. Spaulding, J.-L. Mas, and J.-L. Sablayrolles
Coronary Artery Stenosis in High-risk Patients: 64-Section CT and Coronary Angiography--Prospective Study and Analysis of Discordance
Radiology,
August 1, 2009;
252(2):
377 - 385.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. J. Doyle, C. S. Rihal, D. A. Gastineau, and D. R. Holmes Jr
Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention implications for contemporary practice.
J. Am. Coll. Cardiol.,
June 2, 2009;
53(22):
2019 - 2027.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Z. Potsis, C. Katsouras, and J. A. Goudevenos
Avoiding and Managing Bleeding Complications in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes
Angiology,
April 1, 2009;
60(2):
148 - 158.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
C Pristipino, C Trani, M S Nazzaro, A Berni, G Patti, R Patrizi, B Pironi, P Mazzarotto, G Gioffre, G G L Biondi-Zoccai, et al.
Major improvement of percutaneous cardiovascular procedure outcomes with radial artery catheterisation: results from the PREVAIL study
Heart,
March 15, 2009;
95(6):
476 - 482.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J Sende, P Jabre, B Leroux, C Penet, E Lecarpentier, M Khalid, A Margenet, J Marty, and X Combes
Invasive arterial blood pressure monitoring in an out-of-hospital setting: an observational study
Emerg. Med. J.,
March 1, 2009;
26(3):
210 - 212.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T S Lo, J Nolan, E Fountzopoulos, M Behan, R Butler, S L Hetherington, K Vijayalakshmi, R Rajagopal, D Fraser, A Zaman, et al.
Radial artery anomaly and its influence on transradial coronary procedural outcome
Heart,
March 1, 2009;
95(5):
410 - 415.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Medi, G. Montalescot, A. Budaj, K. A.A. Fox, J. Lopez-Sendon, G. FitzGerald, D. B. Brieger, and on behalf of the GRACE Investigators
Reperfusion in Patients With Renal Dysfunction After Presentation With ST-Segment Elevation or Left Bundle Branch Block: GRACE (Global Registry of Acute Coronary Events)
J. Am. Coll. Cardiol. Intv.,
January 1, 2009;
2(1):
26 - 33.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T Kinnaird, R Anderson, J Hill, and M Thomas
Bleeding during percutaneous intervention: tailoring the approach to minimise risk
Heart,
January 1, 2009;
95(1):
15 - 19.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Hamon and J. Nolan
Should radial artery access be the "gold standard" for PCI?
Heart,
December 1, 2008;
94(12):
1530 - 1532.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. Mlekusch, E. Minar, P. Dick, S. Sabeti, A. Bartok, M. Haumer, M. Bonelli, L. Vormittag, R. Koppensteiner, and M. Schillinger
Access Site Management after Peripheral Percutaneous Transluminal Procedures: Neptune Pad Compared with Conventional Manual Compression
Radiology,
December 1, 2008;
249(3):
1058 - 1063.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Agostoni, L. Testa, and G. G.L. Biondi-Zoccai
Comment on 'Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes'
Eur. Heart J.,
November 2, 2008;
29(22):
2820 - 2821.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
O. F. Bertrand, J. Arsenault, and R. Mongrain
Operator vs. patient radiation exposure in transradial and transfemoral coronary interventions
Eur. Heart J.,
October 2, 2008;
29(20):
2577 - 2578.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. V. Rao and S. Y.H. Kim
Informing the Consent Process
Circ Cardiovasc Qual Outcomes,
September 1, 2008;
1(1):
7 - 8.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. V. Rao, F.-S. Ou, T. Y. Wang, M. T. Roe, R. Brindis, J. S. Rumsfeld, and E. D. Peterson
Trends in the Prevalence and Outcomes of Radial and Femoral Approaches to Percutaneous Coronary Intervention: A Report From the National Cardiovascular Data Registry
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
379 - 386.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A J Chase, E B Fretz, W P Warburton, W P Klinke, R G Carere, D Pi, B Berry, and J D Hilton
Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg)
Heart,
August 1, 2008;
94(8):
1019 - 1025.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. J. Applegate, M. T. Sacrinty, M. A. Kutcher, F. R. Kahl, S. K. Gandhi, R. M. Santos, and W. C. Little
Trends in Vascular Complications After Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Via the Femoral Artery, 1998 to 2007
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
317 - 326.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Hamon and A. Sourgounis
Radiation exposure and vascular access site
Eur. Heart J.,
April 1, 2008;
29(7):
954 - 954.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Brasselet, S. Tassan, P. Nazeyrollas, M. Hamon, and D. Metz
Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI Trial
Heart,
December 1, 2007;
93(12):
1556 - 1561.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Hamon, R. Morello, J. W. Riddell, and M. Hamon
Coronary Arteries: Diagnostic Performance of 16- versus 64-Section Spiral CT Compared with Invasive Coronary Angiography Meta-Analysis
Radiology,
December 1, 2007;
245(3):
720 - 731.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. S. Spence, P. Klinke, and D. Hilton
Letter by Spence et al Regarding Article, "Impact of Patient and Target-Vessel Characteristics on Arterial and Venous Bypass Graft Patency: Insight From a Randomized Trial"
Circulation,
October 9, 2007;
116(15):
e374 - e374.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. A. Murphy, C. M. Gibson, D. A. Morrow, F. Van de Werf, I. B. Menown, S. G. Goodman, K. W. Mahaffey, M. Cohen, C. H. McCabe, E. M. Antman, et al.
Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis
Eur. Heart J.,
September 1, 2007;
28(17):
2077 - 2086.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Sanmartin, R. F. Bonvini, V. Verin, M. Righini, G. W. Stone, M. Hamon, and H. White
Bivalirudin in Acute Coronary Syndromes
N. Engl. J. Med.,
March 8, 2007;
356(10):
1069 - 1071.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Bhala, M. Hamon, J. W. Riddell, G. Karthikeyan, V. Pasceri, J. Schuler, J. Altenberger, M. Heigert, G. Montalescot, H. D. White, et al.
Enoxaparin in elective percutaneous coronary intervention.
N. Engl. J. Med.,
December 28, 2006;
355(26):
2788 - 2789.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
O. F. Bertrand, R. De Larochelliere, J. Rodes-Cabau, G. Proulx, O. Gleeton, C. Manh Nguyen, J.-P. Dery, G. Barbeau, B. Noel, E. Larose, et al.
A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation
Circulation,
December 12, 2006;
114(24):
2636 - 2643.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Hamon, G. G.L. Biondi-Zoccai, P. Malagutti, P. Agostoni, R. Morello, M. Valgimigli, and M. Hamon
Diagnostic Performance of Multislice Spiral Computed Tomography of Coronary Arteries as Compared With Conventional Invasive Coronary Angiography: A Meta-Analysis
J. Am. Coll. Cardiol.,
November 7, 2006;
48(9):
1896 - 1910.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. Montalescot
Glycoprotein IIb/IIIa Inhibitors in the Elderly: Fear of Age or Age of Fear?
Circulation,
November 7, 2006;
114(19):
2004 - 2006.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. H. Lunden, A. Bengtson, and S. M. Lundgren
Hours During and After Coronary Intervention and Angiography
Clin Nurs Res,
November 1, 2006;
15(4):
274 - 289.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
I. C. Gilchrist
Is the Allen's Test Accurate for Patients Considered for Transradial Coronary Angiography?
J. Am. Coll. Cardiol.,
September 19, 2006;
48(6):
1287 - 1287.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Moreno, C. Fernandez, and C. Macaya
Reply
J. Am. Coll. Cardiol.,
January 18, 2005;
45(2):
324 - 325.
[Full Text]
[PDF]
|
 |
|
|