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Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials.

Publication ,  Journal Article
Ferrante, G; Rao, SV; Jüni, P; Da Costa, BR; Reimers, B; Condorelli, G; Anzuini, A; Jolly, SS; Bertrand, OF; Krucoff, MW; Windecker, S; Valgimigli, M
Published in: JACC Cardiovasc Interv
July 25, 2016

OBJECTIVES: The aim of this study was to provide a quantitative appraisal of the effects on clinical outcomes of radial access for coronary interventions in patients with coronary artery disease (CAD). BACKGROUND: Randomized trials investigating radial versus femoral access for percutaneous coronary interventions have provided conflicting evidence. No comprehensive quantitative appraisal of the risks and benefits of each approach is available across the whole spectrum of patients with stable or unstable CAD. METHODS: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized trials comparing radial versus femoral access for coronary interventions. Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Pre-specified subgroup analyses according to clinical presentation, in terms of stable CAD, non-ST-segment elevation acute coronary syndromes, or ST-segment elevation myocardial infarction were performed. RESULTS: Twenty-four studies enrolling 22,843 participants were included. Compared with femoral access, radial access was associated with a significantly lower risk for all-cause mortality (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.87; p = 0.001, number needed to treat to benefit [NNTB] = 160), major adverse cardiovascular events (OR: 0.84; 95% CI: 0.75 to 0.94; p = 0.002; NNTB = 99), major bleeding (OR: 0.53; 95% CI: 0.42 to 0.65; p < 0.001; NNTB = 103), and major vascular complications (OR: 0.23; 95% CI: 0.16 to 0.35; p < 0.001; NNTB = 117). The rates of myocardial infarction or stroke were similar in the 2 groups. Effects of radial access were consistent across the whole spectrum of patients with CAD for all appraised endpoints. CONCLUSIONS: Compared with femoral access, radial access reduces mortality and MACE and improves safety, with reductions in major bleeding and vascular complications across the whole spectrum of patients with CAD.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

July 25, 2016

Volume

9

Issue

14

Start / End Page

1419 / 1434

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Myocardial Infarction
  • Humans
  • Hemorrhage
 

Citation

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Ferrante, G., Rao, S. V., Jüni, P., Da Costa, B. R., Reimers, B., Condorelli, G., … Valgimigli, M. (2016). Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv, 9(14), 1419–1434. https://doi.org/10.1016/j.jcin.2016.04.014
Ferrante, Giuseppe, Sunil V. Rao, Peter Jüni, Bruno R. Da Costa, Bernhard Reimers, Gianluigi Condorelli, Angelo Anzuini, et al. “Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials.JACC Cardiovasc Interv 9, no. 14 (July 25, 2016): 1419–34. https://doi.org/10.1016/j.jcin.2016.04.014.
Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, et al. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016 Jul 25;9(14):1419–34.
Ferrante, Giuseppe, et al. “Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials.JACC Cardiovasc Interv, vol. 9, no. 14, July 2016, pp. 1419–34. Pubmed, doi:10.1016/j.jcin.2016.04.014.
Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, Anzuini A, Jolly SS, Bertrand OF, Krucoff MW, Windecker S, Valgimigli M. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016 Jul 25;9(14):1419–1434.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

July 25, 2016

Volume

9

Issue

14

Start / End Page

1419 / 1434

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Myocardial Infarction
  • Humans
  • Hemorrhage