Safety and efficacy of radial access vs femoral access in st-segment elevation myocardial infarction: a meta- analysis of randomized controlled trials

Background and Aim: The survival benefit associated with radial access compared with femoral access in patients with ST-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI) remains controversial. The aim of this meta- analysis was to assess whether there are additional short-term benefits associated with the use radial access in patients undergoing primary PCI for STEMI. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial and femoral access for primary PCI in patients presenting with STEMI. We identified 14 RCTs with 11,060 patients, 5,480 underwent radial access and 5,580 femoral access, all were followed up for a minimum of 30 days. Data were pooled by meta- analysis using a fixed-effects or a random-effects model, as appropriate. Random effect odds ratios were used for efficacy and safety outcomes. Results: Compared with femoral access, the radial access was associated with a significantly lower risk for all-cause mortality (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54 to 0.86; p = 0.001), major adverse cardiovascular events (OR: 0.83; 95% CI: 0.70 to 0.98; p = 0.03), major bleeding (OR: 0.49; 95% CI: 0.35 to 0.70; p \u3c 0.0001), and major vascular complications (OR: 0.48; 95% CI: 0.36 to 0.64; p \u3c 0.00001). The frequency of acute myocardial infarction or stroke were not different between the two approaches. Conclusions: In patients with STEMI treated by PCI, the radial access approach is associated with less mortality, MACE, major bleeding and vascular complications compared with femoral access