Pooled evidence suggests that accessing the heart through an artery in the arm reduces death and major bleeding events in patients with acute coronary syndrome (ACS) compared to using an artery in the groin. The evidence review is published in Annals of Internal Medicine.

Strategies to avoid bleeding are key to improving the outcomes of patients with ACS who are managed with invasive procedures. Radial access sites are associated with a lower incidence of vascular bleeding complications, but conclusions about whether this approach reduces mortality and ischemic events are inconsistent.

Researchers reviewed four high-quality multicenter trials involving more than 17,000 patients to compare clinical outcomes occurring with radial versus femoral access in invasively managed adults with ACS. The evidence showed that radial access reduced morality, major coronary adverse events, and major bleeding in patients with ACS. The author of an accompanying editorial suggests that cardiologists should become adept at using both approaches.

Abstract: www.annals.org/article.aspx?doi=10.7326/M15-1277

Editorial: www.annals.org/article.aspx?doi=10.7326/M15-2444