Small randomized trials have demonstrated that radial access reduces access site complications
compared to a femoral approach. The objective of this meta-analysis was to determine
if radial access reduces major bleeding and as a result can reduce death and ischemic
events compared to femoral access.
MEDLINE, EMBASE, and CENTRAL were searched from 1980 to April 2008. Relevant conference
abstracts from 2005 to April 2008 were searched. Randomized trials comparing radial
versus femoral access coronary angiography or intervention that reported major bleeding,
death, myocardial infarction, and procedural or fluoroscopy time were included. A
fixed-effects model was used with a random effects for sensitivity analysis.
Radial access reduced major bleeding by 73% compared to femoral access (0.05% vs 2.3%,
OR 0.27 [95% CI 0.16, 0.45], P < .001). There was a trend for reductions in the composite
of death, myocardial infarction, or stroke (2.5% vs 3.8%, OR 0.71 [95% CI 0.49-1.01],
P = .058) as well as death (1.2% vs 1.8% OR 0.74 [95% CI 0.42-1.30], P = .29). There
was a trend for higher rate of inability to the cross lesion with wire, balloon, or
stent during percutaneous coronary intervention with radial access (4.7% vs 3.4% OR
1.29 [95% CI 0.87, 1.94], P = .21). Radial access reduced hospital stay by 0.4 days
(95% CI 0.2-0.5, P = .0001).
Radial access reduced major bleeding and there was a corresponding trend for reduction
in ischemic events compared to femoral access. Large randomized trials are needed
to confirm the benefit of radial access on death and ischemic events.