Meta-analysis comparing radial versus femoral approach in patients 75 years and older undergoing percutaneous coronary procedures.

introductionElderly patients (≥75 years) undergoing coronary angioplasty are increasing. Meta-analyses have shown the benefits of radial access which might reduce hospital stay by decreasing access site complications with associated secondary benefits, however, the population over the age of 75 years were not a large part of the cohort and may behave differently due to increased atherosclerotic burden and age-related vascular changes. In addition, complications unique to this age group such as delirium and deconditioning might occur which could have a bearing on the outcome.

methodsWe searched Pubmed, SCOPUS, Medline, Dynamed, Cochrane. The search terms used were femoral and radial, femoral versus radial, radial or femoral access site, radial or femoral comparison. There were no restrictions.

resultsThere was a significant decrease (85%)in the incidence of access site complications in the radial group. The time to achieve ambulation was lower by 14.25h (8.86-19.56h). However, the incidence of crossover (in effect failure to perform catheterization by radial access) from radial to femoral was significantly higher. Radial access was associated with longer procedural times (2.75min) and increased contrast dose however, there was no statistical difference in the fluoroscopy time between the two.

conclusionsRadial access has similar benefits in elderly patients as those under the age of 75 and may be beneficial in patients at risk of delirium or deconditioning. However, crossover rates, contrast dose and procedure time were higher. It is conceivable that as experience is gained, these rates will diminish.