A comparison of transradial versus transfemoral and standard versus ultrasound-guided approaches in reducing bleeding rates in patients undergoing coronary angiography or angioplasty.

Abstract Aims: This study compared outcomes in unselected patients undergoing cardiac catheterization via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. Methods and Results: A prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularization) and vascular complications at 30 days. Transradial access reduced primary outcome when compared with transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance. Ultrasound guidance however reduced mean access time, attempts, difficult accesses, venipuncture and improved first-pass success. Conclusions: Transradial access significantly reduced composite outcome compared to transfemoral access. Ultrasound guidance did not reduce primary outcome compared to standard technique, but significantly improved efficiency and overall success rate of arterial access.