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ROZZANO, ITALY — Based on a new meta-analysis, an international study team is recommending that radial access through the wrist be used when inserting stents to restore blood flow in heart disease patients, not femoral access through the groin.
The study, published in JACC: Cardiovascular Interventions, said that approach has fewer complications and should be the default methods. Previous randomized trials comparing the two access locations for percutaneous coronary interventions have provided conflicting evidence, however, prompting investigators to try to come up with a more definitive answer.
A team led by researchers from Humanitas Research Hospital in Italy and also including U.S. colleagues from the Duke Clinical Research Institute in Durham, NC, looked at 24 studies involving 22,843 participants to conduct a comprehensive meta-analysis across the range of heart disease.
Compared with femoral access, radial access was associated with a significantly lower risk for all-cause mortality with an odds ratio (OR) of 0.71, major adverse cardiovascular events (MACE) (OR 0.84), major bleeding (OR: 0.53) and major vascular complications (OR 0.23). The rates of myocardial infarction or stroke were similar in the two groups, according to the study authors, who added that effects of radial access were consistent across the whole spectrum of patients with coronary artery disease for all appraised endpoints.
Study authors determined that there was "strong to very strong" evidence that major bleeding and vascular complications were reduced and "moderate to strong" evidence that all-cause death rates were reduced when using radial vs. femoral access.
“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,” study authors concluded.
Radial access is a newer procedure that involves a longer learning curve to develop the technical skills necessary, according to background information in the report.
JACC: Cardiovascular Interventions Editor-in-Chief Spencer King, MD, pointed out, however, "as radial access is increasingly adopted, the benefits seen in trials has been weighed against the learning curve necessary for some operators. This most complete analysis of the value of radial access may convince some doubters to switch."