Background The preferred access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) continues to be debated.
Methods We performed a systematic review and meta-analysis of two randomized trials and eighteen observational studies, including 58,237 patients with prior CABG (27,063 in the radial group; 31,174 in the femoral group) that underwent cardiac catheterization with or without intervention. Outcomes included (1) access-site complications rate; (2) crossover rate to a different vascular access; (3) procedure time; and (4) contrast volume. Data were extracted by two independent authors; using a random effects model, standardized mean differences (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for binary outcomes.
Results Among randomized trials, the crossover rate (OR:12.63; 95% CI: 1.57,101.62; p=0.021) was higher in the radial group, while contrast volume (SMD: 0.15; 95% CI: -0.52, 0.82, p=0.66), procedure time (SMD: 0.49; 95% CI: -0.64, 1.62, p=0.4) and the incidence of access site complications (OR:1.21; 95% CI: 0.36, 4.07; p=0.76) and were similar. Among observational studies, access site complication rates (OR:0.46; 95% CI: 0.25,0.86; p<0.001) and contrast volume (SMD: -0.14; 95% CI: -0.20, -0.07; p=0.03) were lower and crossover rates were higher (OR: 4.79; 95% CI: 1.99, 11.52, p=0.02) in the radial group, while procedure time was similar (SMD: 0.13; 95% CI: -0.08, 0.34, p=0.02).
Conclusions Most data published for radial vs. femoral access in prior CABG patients are observational with only two randomized-controlled trials performed to date. Radial access is associated with lower vascular access complication rates and contrast volume in observational studies and higher rates of crossover to femoral access in both observational and randomized studies.