11 Nov Radial Access For Coronary Angiography Can Reduce Bleeding and Mortality

MedicalResearch.com Interview with:
Dr. Giuseppe Andò
University of Messina, Messina, Italy

Medical Research: What is the background for this study?

Dr. Andò: Patients’ preference for radial access for coronary angiography and percutaneous intervention is paralleled by an almost complete abolition of access-site bleeding. Given the deleterious impact of any clinically relevant bleeding event on short- and long-term outcomes, the use of radial access should translate into a reduction in net adverse events, especially in patients with high risk of bleeding such as those with an acute coronary syndrome. Nonetheless, studies conducted over the past decade by pioneers of radial access were relatively small and not sufficiently compelling to affect guidelines and endorse a change in current practice.

Medical Research: What are the main findings?

Dr. Andò: We have pooled in the present study 4 well-conducted, large, multicenter studies with data from centers with different expertise in radial procedures across America, Europe, Asia and Oceania. We demonstrate that the use of radial access can reduce mortality in patients with acute coronary syndromes undergoing invasive management by a consistent reduction in major bleeding.

Medical Research: What should clinicians and patients take away from your report?

Dr. Andò: The present study consolidates the role of trans-radial intervention as a life-saving procedure. Importantly, the European Society of Cardiology has upgraded the use of radial access from a class IIa to a class I recommendation in the recently released Guidelines on management of patients with acute coronary syndromes. Beyond European recommendations, all femoral-oriented interventional cardiology centers treating patients with acute coronary syndromes should implement the transition to radial access.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Andò: The concept of bleeding avoidance in patients with acute coronary syndromes who receive an invasive management consist in a synergistic combination of pharmacological and mechanical strategies aimed at reducing the risk of bleeding. It remains to be established whether specific anti-thrombotic drugs may act as treatment modifiers of the benefit of radial access. In addition, the radial artery is a small caliber vessel which receives a not negligible traumatic injury during trans-radial procedures which, in turn, carry an inherent risk of late vascular occlusion. With respect to care of radial artery, the optimal strategy for access site management after the procedure, aimed at ensuring long term patency of the radial artery and at allowing re-interventions from the same access site, remain to be assessed.

Citation:

Andò G, Capodanno D. Radial Versus Femoral Access in Invasively Managed Patients With Acute Coronary Syndrome: Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 10 November 2015] doi:10.7326/M15-1277

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Dr. Giuseppe Andò (2015). Radial Access For Coronary Angiography Can Reduce Bleeding and Mortality

Last Updated on November 11, 2015 by Marie Benz MD FAAD