Radial versus femoral access for percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: Trial sequential analysis

Abstract Background Randomized controlled trials (RCTs) have yielded conflicting results about the impact of trans-radial access (TRA) versus trans-femoral access (TFA) in patients with ST-segment elevation myocardial infarction (STEMI). Methods We performed a trial sequential analysis (TSA) of RCTs comparing TRA and TFA in patients with STEMI. The outcomes of interest were 30-day mortality, major bleeding, major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke and access site complications. Results A total of 17 studies; with 11,992 patients were included in the current TSA. The TRA group had lower 30-day mortality (RR 0.72; 95%CI 0.58–0.90, P = .003), major bleeding (RR 0.62; 95%CI 0.49–0.79, P = .0001), MACE (RR 0.74; 95%CI 0.58–0.93, P = .01) and access site complications (RR 0.37; 95%CI 0.28–0.48, P  Conclusion In the current trial sequential analysis, the available data from RCTs support improved 30-day mortality, major bleeding, MACE and access site complications rates in STEMI patients treated by PCI through the radial access.