Radial access versus femoral access in percutaneous coronary intervention in elderly patients : A systematic review

Abstract This review was carried out to determine the best option between the radial and femoral access in percutaneous coronary intervention in older individuals. Studies considered were RCTs and observational studies which were published between Jan 2000 and December 2020, from which, studies comparing radial access with femoral access in elderly patients aged 65 years and older were selected. A comprehensive literature search was conducted utilizing electronic databases including PubMed, Embase, and Cochrane Library. The search strategy included keywords such as “percutaneous coronary intervention”, “radial access”, “femoral access”, and “elderly patients. The quality of the included studies was assessed using appropriate tools for RCTs (e.g., Cochrane Risk of Bias Tool) and observational studies (e.g., Newcastle-Ottawa Scale). The risk of bias was evaluated across different domains, including random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other sources of bias. A total of 10 studies met the inclusion criteria and were selected for analysis. These studies consisted of 5 randomized controlled trials (RCTs) and 5 observational studies. The total sample size across all studies was 3,000 elderly patients. The analysis indicated that radial access was associated with a higher rate of procedural success compared to femoral access in the elderly population (p < 0.05). Furthermore, radial access showed a lower incidence of major bleeding events, access site complications. Some limitations of this systematic review include the heterogeneity among included studies, as well as the limited number of available studies specifically focusing on elderly patients.