Radial versus femoral access and long-term outcomes in ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Background: Radial access (RA) and femoral access (FA) are both accepted vascular approaches for primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). While RA is associated with lower short-term bleeding complications, its effect on long-term outcomes remains uncertain. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines [14]. MEDLINE, Embase, and Cochrane CENTRAL were searched for studies comparing RA and FA in STEMI patients undergoing PCI with follow-up ≥ 30 days. Randomized controlled trials and observational cohort studies were included. Risk of bias was assessed using the Cochrane RoB 2 tool and the Newcastle–Ottawa Scale. Long-term all-cause mortality was pooled using a random-effects model. Results: Nine studies were included, comprising two randomized trials and seven observational cohorts [5–8, 11–13]. RA was associated with a significant reduction in long-term all-cause mortality compared with FA (RR 0.59, 95% CI 0.38–0.91; p = 0.02), with substantial heterogeneity (I² = 93%). MACE and bleeding complications were consistently lower with RA. Conclusion: In STEMI patients undergoing PCI, radial access is associated with improved long-term outcomes compared with femoral access, supporting its role as the preferred access strategy.