The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Cardio Center, Humanitas Clinical and Research Center IRCCS, Milan, Italy.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):1387-1396. doi: 10.1002/ccd.29486. Epub 2021 Jan 28.
It is still debated if benefits associated with radial versus femoral access for coronary angiography and percutaneous coronary interventions (PCI) are due to the access site selection itself, operator expertise or other underlying mechanisms.
We searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access site for coronary angiography and PCI. Primary safety endpoint was major bleeding. Coprimary efficacy endpoints were stroke and myocardial infarction (MI). This study is registered with PROSPERO.
We identified 31 trials (30,096 patients, PCI performed in 21,225 patients). Radial compared to femoral access was associated with a significant risk reduction in major bleeding (OR 0.53, 95%CI 0.42-0.66, I = 3.3%). Findings were consistent regardless of clinical characteristics or whether coronary angiography was performed with or without PCI. The benefit of radial access was significantly increased in studies published before 2010 and in patients with chronic coronary syndrome. Risk for stroke (OR 1.11, 95%CI 0.76-1.64, I = 0%) and MI (OR 0.90, 95%CI 0.79-1.04, I = 0%) were comparable between the groups. Risk for mortality and vascular complications were significantly lower with radial than femoral access.
In patients undergoing coronary angiography and PCI, radial access is associated with a significant risk reduction in bleeding, vascular complications, and mortality compared to femoral access. The risk of stroke or MI were comparable in patients with radial or femoral access.
经桡动脉与股动脉入路行冠状动脉造影和经皮冠状动脉介入治疗（PCI）的获益是否归因于入路部位的选择、术者经验或其他潜在机制，目前仍存在争议。
我们检索了 PubMed、Embase 和会议摘要中比较经桡动脉与股动脉入路行冠状动脉造影和 PCI 的随机试验。主要安全性终点为大出血。共同主要疗效终点为卒中和心肌梗死（MI）。本研究已在 PROSPERO 注册。
我们共纳入 31 项试验（30096 例患者，21225 例患者行 PCI）。与股动脉入路相比，桡动脉入路与大出血风险显著降低相关（OR 0.53，95%CI 0.42-0.66，I ² = 3.3%）。无论临床特征如何，以及是否行冠状动脉造影联合或不联合 PCI，结果均一致。2010 年前发表的研究和慢性冠状动脉综合征患者中，桡动脉入路的获益显著增加。两组间卒中和 MI 的风险无显著差异（OR 1.11，95%CI 0.76-1.64，I ² = 0%；OR 0.90，95%CI 0.79-1.04，I ² = 0%）。与股动脉入路相比，桡动脉入路的死亡和血管并发症风险显著降低。
在接受冠状动脉造影和 PCI 的患者中，与股动脉入路相比，桡动脉入路可显著降低出血、血管并发症和死亡率风险。桡动脉与股动脉入路患者的卒中或 MI 风险无显著差异。
