Background: Acute coronary syndrome (ACS) necessitates immediate and efficient management, often using percutaneous coronary intervention (PCI) as a popular treatment method. The selection of the access site, whether it is transradial access (TRA) or transfemoral access (TFA), may have a substantial effect on clinical results.
Objective: This study aimed to compare TRA and TFA in terms of PCI-related bleeding complications, access site complications, procedural duration, and hospital mortality in ACS patients undergoing PCI.
Patients and Methods: A prospective, randomized, controlled trial was conducted on a total of 150 patients presenting with ACS indicated for PCI. They were randomized into two groups: 75 patients in the TRA group and 75 patients in the TFA group. Primary outcomes were bleeding complications and major adverse cardiac events (MACE). Secondary outcomes included cardiovascular death, stent thrombosis, and urgent revascularization.
Results: Hematoma occurred significantly more in the TFA group (13.3%) compared to the TRA group (0%) (P = 0.001). The incidence of MACE was higher in the TFA group (13.3%) than in the TRA group (6.7%) but without statistical significance (P = 0.174). Multivariate logistic regression analysis revealed that femoral access was associated with a non-significant two-fold increased risk of MACE (OR = 2.181, 95% CI: 0.697–6.824, P = 0.18).
Conclusion: TRA is associated with fewer hematoma complications and a trend toward lower MACE compared to TFA in ACS patients undergoing PCI. TRA may be preferred for reducing access site complications.