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

Objectives. We sought to compare outcomes with radial vs femoral approach in female patients undergoing coronary angiography. Background. Women undergoing cardiac procedures have increased risk of bleeding and vascular complications, but are under-represented in randomized clinical trials [RCTs] involving coronary angiography. Methods. We performed a meta-analysis of RCTs comparing outcomes in women undergoing angiography with radial vs femoral approaches. The primary outcome was non-coronary artery bypass graft [CABG] related bleeding at 30 days. Secondary outcomes included major adverse cardiovascular or cerebrovascular events [MACCE; a composite of death, stroke or myocardial infarction], vascular complications, procedure duration, and access-site crossover. Results. Four studies [n = 6041 female patients] met the inclusion criteria. In female patients undergoing coronary angiography, radial access decreased non-CABG related bleeding (odds ratio [OR], 0.56; 95% confidence interval [Cl], 0.44-072; P<.001], MACCE (OR, 073; 95% CI, 0.58-0.93; P=.01), vascular complications [OR, 0.49; 95% CI, 0.32-0.75; P<.001] with no significant difference in procedure time [mean difference, 0.04; 95% CI, -0.97 to 0.89; P=.93). There was an increase in access-site crossover using the radial approach [OR, 2.86; 95% CI, 2.24-3.63; P<.001]. 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<.001]. Conclusions. In female patients undergoing coronary angiography or intervention, the radial approach is associated with decreased bleeding, MACCE, and vascular complications. These data suggest that radial access should be the preferred approach for women.