Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention

Matthew D. Mitchell, Jaekyoung A. Hong, Bruce Y. Lee, Craig A. Umscheid, Sarah Bartsch, Creighton W. Don

Research output: Contribution to journalReview articlepeer-review


Background-Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost-benefit analysis of radial catheterization based on results from a systematic review of published randomized controlled trials. Methods and Results-The systematic review added 5 additional randomized controlled trials to a prior review, for a total of 14 studies. Meta-analyses, following Cochrane procedures, suggested that radial catheterization significantly increased catheterization failure (OR, 4.92; 95% CI, 2.69-8.98), but reduced major complications (OR, 0.32; 95% CI, 0.24-0.42), major bleeding (OR, 0.39; 95% CI, 0.27-0.57), and hematoma (OR, 0.36; 95% CI, 0.27-0.48) compared with femoral catheterization. It added approximately 1.4 minutes to procedure time (95% CI, -0.22 to 2.97) and reduced hemostasis time by approximately 13 minutes (95% CI, -2.30 to -23.90). There were no differences in procedure success rates or major adverse cardiovascular events. A stochastic simulation model of per-case costs took into account procedure and hemostasis time, costs of repeating the catheterization at the alternate site if the first catheterization failed, and the inpatient hospital costs associated with complications from the procedure. Using base-case estimates based on our metaanalysis results, we found the radial approach cost $275 (95% CI, -$374 to -$183) less per patient from the hospital perspective. Radial catheterization was favored over femoral catheterization under all conditions tested. Conclusion-Radial catheterization was favored over femoral catheterization in our cost-benefit analysis.

Original languageEnglish (US)
Pages (from-to)454-462
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Issue number4
StatePublished - Jul 2012
Externally publishedYes


  • Coronary angiography
  • Cost-benefit analysis
  • Femoral artery
  • Heart catheterization
  • Meta-analysis
  • Radial artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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