In angiography, transradial access bests transfemoral access for 30-day mortality, bleeding
In a meta-analysis of seven trials of patients who had coronary angiography with or without PCI, those who had transradial access had lower 30-day rates of mortality and major bleeding compared with those who had transfemoral access.
“Our study provides comprehensive evidence from high-quality multicenter trials that the use of transradial access over transfemoral access is associated with reduced all-cause mortality [and] reduced major bleeding,” Giuseppe Gargiulo, MD, PhD, assistant professor of cardiology at University Federico II of Naples, Italy, said during a press conference at the European Society of Cardiology Congress. “This individual patient data meta-analysis provides evidence that transradial access should be considered the gold standard access site for percutaneous coronary procedures, particularly in acute coronary syndromes.”
The Radial Trialists’ Collaborative researchers analyzed 21,600 patients (median age, 64 years; 32% women; 95% with ACS; 75.2% had PCI) from seven randomized controlled trials of transradial vs. transfemoral access in coronary angiography with or without PCI. The findings were simultaneously published in Circulation.
At 30 days, the rate of all-cause mortality was 1.6% in those assigned the transradial approach and 2.1% in those assigned the transfemoral approach (HR = 0.77; 95% CI, 0.63-0.95; P = .012). The rate of major bleeding was 1.5% in the transradial group and 2.7% in the transfemoral group (OR = 0.55; 95% CI, 0.45-0.67; P < .001), according to the researchers.
The benefit of survival with transradial access was substantial in patients with significant anemia at baseline (HR = 0.35; 95% CI, 0.2-0.61; P for interaction with patients with nonsignificant or no anemia = .003), Gargiulo said at the press conference.
Results were consistent in the PCI, ACS and acute MI populations, according to the researchers.
“The survival benefit with transradial access is only partially mediated by major bleeding reduction, and additional access-site related mechanisms are required to fully explain this treatment effect,” Gargiulo said.
Gargiulo said that while various guidelines recommend the transradial approach for diagnostic angiography and PCI, “these recommendations were mainly based on the advantages of transradial access in major bleeding, vascular complications, shorter hospital stay and higher patient quality of life. Now we have definitive data that transradial access reduces mortality.”
Reference:
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We had a pretty definitive answer to begin with, but these results are reassuring, thanks to the power of bigger numbers. Perhaps the greatest benefit from transradial access is derived in those with anemia. That was somewhat expected because those with anemia are going to be at higher risk for bleeding complications later on, and transradial access lowers that risk further.
Of interest is that the reduction in bleeding did not entirely explain the mortality benefit with the transradial approach. Maybe that is due to the fact that these patients are ambulating quicker and leaving the hospital quicker, which means they are not in bed as long and not getting as much sedation. There are other explanations, though the main driver is the bleeding.
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Gargiulo G, et al. Hot Line 9. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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