Radial versus Femoral Approach in Women Undergoing Coronary Angiography: A Meta-analysis of Randomized Controlled Trials

Hussain, Fizza

Radial versus Femoral Approach in Women Undergoing Coronary Angiography: A Meta-analysis of Randomized Controlled Trials

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Shadi Al Halabi, MD MPH , Loyola University Medical Center, Maywood, IL

Fizza Hussain , Loyola University Medical Center, Maywood, IL

Lucas Burke, M.D. , Loyola University Medical Center, Maywood, IL

John J. Lopez, M.D. , Loyola University Medical Center, Maywood, IL

Verghese Mathew, M.D., FSCAI , Loyola University Medical Center, Maywood, IL

Ivo Bernat, PhD , University Hospital Pilsen, Pilsen, Czech Republic

Adhir R. Shroff, M.D., FSCAI , University of Illinois-Chicago, Chicago, IL

Background:
Women undergoing percutaneous coronary intervention (PCI) have increased risk of bleeding and vascular complications, but women are underrepresented in trials involving coronary angiography.

Methods:
We compared radial versus femoral approach in females undergoing coronary angiography through a meta-analysis of randomized controlled trials. The primary outcome was non-CABG related bleeding at 30 days. Secondary outcomes included major adverse cardiovascular or cerebrovascular events or MACCE (a composite of death, stroke or MI), vascular complications, procedure duration and access site crossover.

Results:
Four studies (6041 patients) met our inclusion criteria. Radial access decreased non-CABG related bleeding (OR 0.56; 95% CI: 0.44-0.72, p<0.001), MACCE (OR 0.73; 95% CI: 0.58-0.93, p=0.01), vascular complications (OR 0.49; 95% CI: 0.32-0.75; p<0.001) with no significant difference in procedure time (mean difference 0.04; 95% CI: -0.97-0.89, p=0.93). There was an increase in access site crossover using the radial approach (OR 2.86; 95% CI: 2.24-3.63; p<0.0001). Patients undergoing radial approach were more likely to prefer radial access for the next procedure (OR 6.96; 95% CI: 5.70-8.50, p<0.0001).

Conclusions:
The results of this meta-analysis suggest women benefit from a “radial-first” approach without significant difference in procedure time.