Supplemental Material includes:

Figure legends for Figures from 1 to 9

Tables from Table 1 to Table 4

Figures 1 to 9

1

Figure legend:

Figure 1. Risk of bias summary: judgements about each risk of bias item for each included study.

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Figure 2. Contour-enhanced funnel plot for all-cause death for the pooled analysis of studies

comparing radial vs femoral access.

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Figure 3. Contour-enhanced funnel plot for MACE comparing radial vs femoral access.

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Figure 4. Contour-enhanced funnel plot for myocardial infarction comparing radial vs femoral

access.

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Figure 5. Contour-enhanced funnel plot for stroke comparing radial vs femoral access.

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Figure 6. Contour-enhanced funnel plot for major bleeding comparing radial vs femoral access.

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Figure 7. Contour-enhanced funnel plot for major vascular complications comparing radial vs

femoral access.

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Figure 8. Contour-enhanced funnel plot for NACE comparing radial vs femoral access.

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Figure 9: Pooled analysis of studies comparing radial vs femoral access. Forest plot reporting

trial-specific and summary odds ratios (OR) with 95% confidence interval (CI) for the endpoint

of NACE in analysis restricted to ACS patients and across subgroups.

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Tables

Table 1. Heterogeneity. Pooled analysis of studies comparing radial vs femoral access.

Endpoint Heterogeneity chi2 df P Tau2 I2(%)

All-cause death 20.35 21 0.49 0 0

Major bleeding 20.61 23 0.60 0 0

MACE 20.46 22 0.55 0 0

MI 3.29 12 0.99 0 0

Stroke 5.34 10 0.87 0 0

Major vascular complications 9.40 19 0.97 0 0Df = degree of freedom; I2 = inconsistency;MACE: major adverse cardiovascular events; MI = myocardial infarction; Tau2 = between-study variance Tau-squared; TIMI = thrombolysis in myocardial infarction.

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Table 2. Heterogeneity. Subgroup analyses of studies comparing radial vs femoral access.

Endpoint Heterogeneity chi2 df P Tau2 I2(%)

Stable syndromes

All-cause death 2.33 4 0.67 0 0

Major bleeding 2.03 5 0.84 0 0

MACE 6.78 5 0.24 0.10 26.2

MI 0.03 4 1 0 0

Stroke 0 0 NE 0 NE

Major vascular complications 1.39 5 0.93 0 0

NSTE-ACS

All-cause death 9.46 2 0.009 0.59 78.9

Major bleeding 0.27 2 0.87 0 0

MACE 5.74 2 0.057 0.06 65.2

NACE 3.49 2 0.17 0.02 42.7

STEMI

All-cause death 6.97 13 0.90 0 0

Major bleeding 12.9 14 0.53 0 0

MACE 6.97 13 0.90 0 0

NACE 15.08 7 0.035 0.03 53.6

ACS (NSTE-ACS +

STEMI)

MI 2.86 7 0.89 0 0

Stroke 4.76 9 0.85 0 0

Major vascular complications 6.75 14 0.94 0 0

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NE: not estimable; ACS: acute coronary syndromes; NSTE-ACS: non ST segment elevation acute coronary syndrome; STEMI: ST segment elevation myocardial infarction; Df = degree of freedom; I2 = inconsistency; MACE: major adverse cardiovascular events; NACE: net adverse clinical outcomes; MI = myocardial infarction; Tau2 = between-study variance Tau-squared;

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Table 3. Publication bias Harbord’s test. Pooled analysis of studies comparing radial vs

femoral access.

Endpoint Coefficient 95% CI P

All-cause death -0.41 -1.19 to 0.36 0.28

Major bleeding -0.99 -1.64 to -

0.33

0.005

MACE -0.32 -0.96 to 0.31 0.30

MI 0.13 -0.35 to 0.62 0.56

Stroke -0.54 -1.63 to 0.55 0.29

Major vascular

complications

-0.61 -1.54 to 0.32 0.19

NACE* -1.35 -3.60 to 0.89 0.19

CI: confidence interval, MACE: major adverse cardiovascular events; NACE: net adverse clinical outcomes; MI = myocardial infarction; *assessed in patients with acute coronary syndromes.

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Table 4. Number needed to treat to benefit or to harm. Pooled analysis of studies comparing radial vs femoral.

Endpoint NNTB/NNTH 95% CI No of events avoided per 1000 (95% CI)

All-cause death NNTB 160 NNTB 110 to 357 6.2 (2.8 to 9.1)

Major bleeding NNTB 103 NNTB 84 to 141 9.7 (7.1 to 11.8)

MACE NNTB 99 NNTB 63 to 263 10.1 (3.8 to 15.8)

MI NNTB 286 NNTB 116 to ∞ to NNTH 435 3.5 (8.6 to ∞ to -2.3 )

Stroke NNTH 4190 NNTH 384 to ∞ to NNTH

714

0.2 (2.6 to ∞ to -1.4)

Major vascular complications NNTB 117 106 to 137 8.6 (7.3 to 9.4)

NACE* NNTB 48 31 to 141 20.7 (7.1 to 32.2)

CI: confidence interval; NNTB: number needed to treat to benefit;NNTH: number needed to treat to harm; MI: myocardial infarction; *assessed in patients with acute coronary syndromesMACE: major adverse cardiovascular events; NACE: net adverse clinical outcomes; MI = myocardial infarction.

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