Key Points
- Transradial access has emerged as the preferred initial access method for coronary angiography, largely due to evidence supporting its association with reduced bleeding risk. However, the difference between transradial and transfemoral access with regards to mortality is not clear. The RTC study was an individual patient data meta-analysis to examine the effect of transradial vs transfemoral access on 30-day mortality and bleeding risk.
- Transradial access resulted in reduced 30-day mortality and major bleeding compared to transfemoral. This result was seen regardless of indication for angiography (ie, ACS vs non-ACS) or whether or not PCI was performed. The reduction in mortality was especially substantial in patients with significant baseline anemia.
Over the past decade, radial access for coronary angiography has evolved into the preferred method of access over femoral due to the lower rates of vascular complications and site-related bleeding. However, the effect of radial vs femoral access on mortality has been unclear. In a breaking presentation at the 2022 European Society of Cardiology Conference today, Dr. Giuseppe Gargiulo (Federico II University Hospital, Naples) and his team presented their individual patient data meta-analysis, “Impact of mortality and major bleeding on radial versus femoral artery access for coronary angiography or percutaneous coronary intervention: a meta-analysis of individual patient data from seven multicenter randomized clinical trials,” or the RTC study.
The RTC study was an individual patient data meta-analysis assessing the effect of transradial vs transfemoral access on mortality and bleeding in patients undergoing coronary angiography with or without PCI. The inclusion criteria for trials included all multicenter RCTs with at least 100 patients per arm and which were published between 2005-2021. A total of 7 trials were included, which included 21,600 patients, half of which had underwent transradial access and the other half transfemoral. The mean age was 64, and 31% of patients were women. 5% of patients were undergoing angiography for stable coronary disease, and the remainder for ACS; 75% of patients underwent PCI. The prespecified primary endpoint was 30-day all-cause mortality; patients who underwent transradial access had a significantly lower risk (HR 0.77, CI 0.63-0.95; p =0.012). On sensitivity analyses, the result was consistent whether or not the patients were experiencing ACS or undergoing PCI. One specific subgroup of interest was those with baseline anemia, who had an especially substantial reduction in mortality with transradial access (HR 0.35, CI 0.2-0.61; p=0.003). The co-primary outcome, 30-day major bleeding, was also significantly reduced in the transradial group (HR 0.55, CI 0.45-0.67; p<0.001).
When discussing the implications of the study at the ESC, Dr. Gargiulo stated: “Among operators with established proficiency in transradial access, it was associated with reduced 30-day all-cause mortality and bleeding…the bleeding benefit appears consistent across numerous sensitivity and subgroup analyses, whereas the mortality reduction seems substantial especially in patients with significant baseline anemia.”