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Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials
  1. Mamas A Mamas1,2,
  2. Karim Ratib3,
  3. Helen Routledge4,
  4. Farzin Fath-Ordoubadi1,
  5. Ludwig Neyses1,2,
  6. Yves Louvard5,
  7. Douglas G Fraser1,
  8. Jim Nolan3
  1. 1Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, Manchester, UK
  2. 2Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  3. 3University Hospital of North Staffordshire, Stoke-on-Trent, UK
  4. 4Worcestershire Royal Hospital, Worcester, UK
  5. 5Institute Cardiovasculaire Paris Sud, Institut Hospitalier Jacquer Cartier, Massy, France
  1. Correspondence to Dr Mamas A Mamas, Clinical Lecturer in Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9PT, UK; mamasmamas1{at}


Objective A meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI).

Design A Medline and Embase search was conducted using the search terms ‘transradial,’ ‘radial’, ‘STEMI’, ‘myocardial’ and ‘infarction’.

Setting Randomised controlled studies that compare outcomes of transradial versus the transfemoral route.

Patients A total of nine studies were identified that consisted of 2977 patients with STEMI.

Interventions Studies that compare outcomes of transradial versus the transfemoral route.

Main outcome measures The primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications.

Results Transradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p=0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p=0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route.

Conclusions This meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.

  • Radial
  • femoral
  • access site
  • outcomes
  • PCI
  • angina—unstable
  • angina
  • cardiac catheterisation
  • heart muscle disease
  • angiography
  • endothelial function
  • interventional cardiology
  • coronary stenting
  • coronary angioplasty (PCI)
  • coronary intervention (PCI)
  • coronary angiography
  • acute coronary syndrome
  • primary PCI
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  • See Editorial, p 269

  • MAM and KR are joint first authors who contributed equally to the manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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