Radial vs femoral access for percutaneous coronary intervention: temporal trends and outcomes in the USA
Authors' conclusion
Based on instrumental variable analyses, PCI with radial access site had lower rates of in-hospital mortality, major access site bleeding, and other major vascular complications compared with femoral access site but a slightly higher risk of ischaemic stroke in contemporary practice.
Study context
- Population
- Percutaneous Coronary Intervention (PCIs) in the US NCDR CathPCI Registry, 1 January 2013 to 30 June 20222,420,805 in safety analysis
- Participants
- 6,658,479 PCI procedures
- Exposure
- Radial vs femoral access for PCI
- Radialn = 2,690,355
- Outcome
- Radial access use (temporal trend) and comparative safety
Methodological detailsinstrumental variable analysis, NCDR CathPCI Registry
- Instrumental variable analysis
- NCDR CathPCI Registry
Main finding
As reported in the abstract
Radial vs FemoralARD, % (95% CI)
In-hospital mortality
−.15(−.20 to −.10)
Major access site bleeding
−.64(−.68 to −.60)
Other major vascular complications
−.21(−.23 to −.18)
Ischaemic stroke (higher with radial)
.05(.03-.08)
- PCIs via radial access overall
- 40.4%
- Radial access in 2013
- 20.3%
- Radial access in 2022
- 57.5%
Observational data: associations, not effects.
Further findings
Falsification endpoint: gastrointestinal or genitourinary bleeding
- No association with the falsification endpoint (instrumental variable analysis)
- Absolute risk difference (ARD) .00%, 95% CI −.03-.03
Original publication
Radial vs femoral access for percutaneous coronary intervention: temporal trends and outcomes in the USA. Eur Heart J. Published 4 July 2025. doi:10.
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