BARCELONA — For coronary angiography with or without percutaneous coronary intervention (PCI), radial access bested femoral access not only for reduced bleeding, but mortality as well, according to a meta-analysis by the Radial Trialists’ Collaboration.
Compared with transfemoral procedures, transradial procedures were associated with reductions in both 30-day all-cause mortality (1.6% vs 2.1%, adjusted HR 0.76, 95% CI 0.61-0.94) and major bleeding (1.5% vs 2.7%, adjusted HR 0.49, 95% CI 0.39-0.60), reported Giuseppe Gargiulo, MD, PhD, of University Federico II of Naples, Italy.
His group analyzed seven higher-quality multicenter randomized trials that had data available at the individual level for 21,600 patients with suspected or confirmed coronary artery disease. This meta-analysis, presented at the European Society of Cardiology (ESC) Congress, was simultaneously published in Circulation.
European and U.S. guidelines already endorse a radial-first strategy coronary intervention because of its relative safety.
“Now we have definitive data that transradial access reduces mortality,” Gargiulo emphasized.
He noted that the survival benefit associated with radial access was namely seen in people with significant anemia, not those with mild or no baseline anemia.
“Whether the absence of a statistically significant prognostic advantage of TRA [transradial access] over TFA [transfemoral access] in the subgroup of patients with milder or no anemia reflects a power issue, in a relatively low-risk study cohort, warrants further analysis,” the authors wrote.
They cautioned that clinicians should not prioritize transradial access only in people with documented baseline anemia, “especially considering that this information may be unknown at the time of access