- Question
- Is radial access superior to femoral access in patients with acute coronary syndromes (ACS) undergoing coronary angiography with possible percutaneous coronary intervention (PCI)?
- Design
- Multicentre, parallel-group randomised trial with 1:1 allocation through a central automated voice response system. It enrolled 7021 patients from 158 hospitals in 32 countries. Patients and investigators were not masked; a masked central committee adjudicated the primary outcome and its components.
- Population
- Patients with acute coronary syndrome in whom coronary angiography with possible intervention was planned.
- Intervention
- Radial artery access for coronary angiography and PCI (3507 patients).
- Control
- Femoral artery access for coronary angiography and PCI (3514 patients).
- Primary outcome
- Composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days.
- Results
- The primary outcome occurred in 128 patients (3.7%) with radial access and 139 (4.0%) with femoral access (HR 0.92; 95% CI 0.72-1.17; p=0.50). Among secondary findings, large haematoma was less frequent with radial access (42 vs. 106 patients; HR 0.40; 95% CI 0.28-0.57; p<0.0001).
- Safety
- Radial access reduced local vascular complications: pseudoaneurysm needing closure occurred in 7 patients with radial access versus 23 with femoral access (HR 0.30; 95% CI 0.13-0.71; p=0.006). Non-CABG-related major bleeding was 0.7% with radial and 0.9% with femoral access (HR 0.73; 95% CI 0.43-1.23; p=0.23).
- Conclusion
- Radial access was not superior to femoral access for the primary outcome, although both approaches were safe and effective, with fewer local vascular complications with the radial route.
- Why it matters
- The trial showed that both access routes are valid options for PCI in ACS and that the lower risk of local vascular complications may favour choosing radial access. Subgroup analyses suggested a possible benefit in high-volume radial centres and in ST-segment elevation myocardial infarction, findings that should not be considered conclusive.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026