Nine RCTs (2,977 patients) were included. Size of the trials varied (from 50 to 1,958 patients). All studies used intention-to-treat analyses, and cross-over rates of up to 12% were reported.
Mortality was significantly lower for the radial group (OR 0.53; 95% CI 0.33 to 0.84; eight trials). Removal of the largest study in the meta-analysis showed a difference in favour of the radial group which was not statistically significant.
There was a significant difference in major adverse cardiac events which favoured the radial group (OR 0.62; 95% CI 0.43 to 0.90; nine trials). The odds of a major bleeding event were lower for the radial group (OR 0.63; 95% CI 0.35 to 1.12; eight trials) but this difference was not statistically significant. Significantly less access site complications were observed in the radial group (OR 0.30; 95% CI 0.19 to 0.48; five trials).
There was no evidence of heterogeneity (Ι²=0%) for the analyses on mortality, major adverse cardiac events and major bleeding outcomes. No evidence of publication bias was found.