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The European Society of Cardiology's new guidelines for the management of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) emphasize the use of radial over femoral access. To update previous systematic reviews of studies into this choice, investigators identified 17 trials and examined the 4 studies that were of high quality.
Pooled data on the 17,133 patients with ACS who were undergoing percutaneous coronary intervention from the four trials showed that radial access significantly reduced death, major adverse coronary events, and major bleeding. However, radial access was associated with a fourfold higher risk for access-site crossover (for switching from radial to femoral access, 6.3% vs. 1.7%). Of note, heterogeneity across st…