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[32] Torres C. Telemedicine has more than a remote chance in prisons. Nat Med 2010;16:496. 0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.04.022 Radial approach for patients with ST-segment elevation acute coronary syndrome: It is definitely the best access site Yao-Jun Zhang a,b , Bo Xu c , Patrick W. Serruys b , Christos V. Bourantas b , Javaid Iqbal b , Takashi Muramatsu b , Ming-Hui Li a , Fei Ye a , Nai-Liang Tian a , Hector M. Garcia-Garcia b , Shao-Liang Chen a, ⁎ a Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China b Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands c Fuwai Hospital, National Center for Cardiovascular Diseases of China, Beijing, China article info Article history: Received 6 April 2013 Accepted 12 April 2013 Available online 9 May 2013 Keywords: Radial approach Femoral approach Meta-analysis Acute myocardial infarction To the Editor: Transradial approach for percutaneous coronary intervention (PCI) has been widely accepted since its introduction by Kiemeneij and Laarman in 1993[1]. The advantages of this approach over the conventional transfemoral approach include reduction in vascular complications such as hematoma, pseudoaneurysm, reduction in cost of hospitalization, and improvement in quality of life[2]. In particular, radial artery access for ST-elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in mortality, potentially due to reduction in bleeding-related complications[3,4]. A meta-analysis by Mamas et al. demonstrated a significant reduction in mortality and major access site complications but no significant difference in the major bleeding events in patients admitted with STEMI treated via transradial access compared to the patients treated via transfemoral approach [5]. Conversely, another meta-analysis by Jang et al. showed that transradial PCI significantly improves clinical outcomes and reduces the risk of periprocedural bleeding[6]. However, the reduction in major bleeding events in radial approach group was only observed in the non-randomized studies in this meta-analysis. Recently, the RIFLE-STEACS (radial versus femoral randomized investigation in ST-Elevation Acute Coronary Syndrome) study was published[3]. In this large volume randomized trial comparing radial and femoral access for patients with STEMI, radial artery access was associated with significant clinical benefits, including a lower morbidity and cardiac mortality. These findings, together with those of previous studies, drove us performing an updated meta-analysis implementing an already established methodology [5–7]. In this meta-analysis, we included 10 randomized trials involving 3978 STEMI patients[3–6]. We found not only a reduction in mortality (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.39–0.76, p b 0.001; Fig. 1A) and major adverse cardiac events (MACE, OR: 0.64, 95% CI: 0.48– ⁎ Corresponding author at: Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing city, Jiangsu Province, 210006, China. E-mail address: chmengx126@gmail.com (S.-L. Chen). 3140 Letters to the Editor