Our complete search strategy is described in the S1 File. Also, we looked for cross-references in the screened studies, review articles, and prior similar meta-analysis along with conference proceedings to identify studies that can be potentially included. We searched PubMed and Embase for all studies on patients with ACS undergoing PCI (Since inception to April 2021) published in the English language. Hence, we aimed to do an updated systematic review and metanalysis to understand the safety and efficacy of TRA Vs TFA in patients with the ACS undergoing PCI. None of the included randomized studies were powered for all-cause mortality events. In contrast to prior studies, a recently published study showed no difference in outcomes according to the access (4). Major scientific societies recommend trans-radial procedures in patients with ACS. Many randomized studies comparing trans-radial and trans-femoral approaches in patients with coronary artery disease are available. PCI using trans-femoral approach (TFA) was embraced initially, and was replaced by the trans-radial approach (TRA). Percutaneous coronary intervention (PCI) is an established treatment of patients with ACS. Management of acute coronary syndrome (ACS) has evolved over a period of time to reach its current position. Cardiovascular diseases are one of the leading causes of morbidity and mortality affecting millions of people worldwide.
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