Sex Differences in Access-site and Clinical Outcomes Following Transradial Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis examined sex-specific procedural, access-site, and clinical outcomes after radial or distal radial percutaneous coronary intervention, using randomized and observational studies. Across nine studies involving 214,638 patients, women had more access-site crossover, bleeding, hematoma, and radial artery spasm than men. The largest reported access-site difference was for spasm (RR 3.40, 95% CI 1.30 to 8.87). Women also had higher cardiovascular mortality and major bleeding, while rates of myocardial infarction, stroke, and major adverse cardiac events were similar. The contribution of access route itself remains uncertain.

Key findings

• Women had higher access-site crossover than men (RR 1.87, 95% CI 1.58 to 2.22).
• Access-site bleeding was more frequent in women (RR 1.84, 95% CI 1.23 to 2.75), as were hematoma and radial artery spasm.
• Women had higher cardiovascular mortality (RR 1.75, 95% CI 1.14 to 2.69) and major bleeding (RR 1.51, 95% CI 1.24 to 1.84).
• All-cause mortality, myocardial infarction, stroke, and major adverse cardiac events were similar between sexes.

Why it matters

Radial access is associated with fewer bleeding and vascular complications than transfemoral access, but this analysis indicates that sex-related differences in access-site complications and some clinical outcomes may persist with radial or distal radial PCI. Recognising these differences can inform interpretation of procedural outcomes and highlight the need to understand which patient, clinical, or procedural factors contribute to them.

What to keep in mind

The review included both randomized and observational studies, and the authors state that the contribution of vascular access itself is uncertain because other clinical and procedural factors may influence outcomes.