Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2023.01.005Get rights and content

The aim of this study was to compare the efficacy and safety of transradial approach (TRA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the efficacy and safety of transfemoral approach (TFA). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) reporting the outcomes of TRA versus TFA in CTO PCI. The primary end point was procedural success. Secondary end points included access-site complications, in-hospital adverse events, procedural efficacy outcomes, and 30-day all-cause mortality. A total of 28,754 CTO PCI cases from 19 studies were included (2 RCTs and 17 OS). The pooled mean J-CTO score is 2.3. The main analysis showed a trend toward a higher success rate for TRA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.00 to 1.38), but this was not the case in the secondary analysis, which included only RCTs and OS with moderate risk of bias (OR 0.99, 95% CI 0.81 to 1.22). TRA was associated with significant reductions in access-site complications (OR 0.33, 95% CI 0.24 to 0.45) and major bleeding (OR 0.34, 95% CI 0.20 to 0.59), and a similar risk of other in-hospital adverse events and 30-day mortality (p >0.05) to that of TFA. Moreover, there was less fluoroscopy time (minutes) and contrast volume use (ml) in the transradial CTO PCI (mean difference: −6.19 [−10.98 to −1.40] and −22.14[−34.56 to −9.72], respectively). In conclusion, the transradial PCI in appropriate CTO lesions was associated with a lower incidence of access-site complications/major bleeding than was TFA and a similar other periprocedural complications rate, without compromising procedural success.

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CABG = coronary artery bypass graft; OS = observational studies; RCTs = randomized controlled trials.

Section snippets

Methods

We performed an electronic search using PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases from inception to July 2022 without language restrictions. Search terms and the number of results per database are shown in Supplementary Method 1. The reference lists of the retrieved studies were screened for any additional studies not identified with the initial search. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and

Results

Our search strategy retrieved 1,867 references; the study selection process is summarized in Figure 1. Nineteen studies were selected for inclusion, containing 2 cohorts from RCTs12,13 and 17 cohorts from OS,4,23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 with a total of 28,754 CTO PCI cases, 10,386 with TRA (36.12%), and 18,368 with TFA (63.88%). Most studies were performed in Europe and North America, of which 4 were multicenter registries.4,31,37,38 The number of cases

Discussion

To our knowledge, this is the largest systematic review and meta-analysis to date, reporting on studies comparing the transradial with the transfemoral approach for treating CTO by PCI. The salient findings of our synthesis of 19 studies, including 28,754 cases, are 1) the procedural success rate of CTO cases that underwent PCI was comparable between TRA and TFA; (2) TRA in CTO PCI resulted in a significantly lower incidence of access-site complications and major bleeding than did TFA; 3) a

Disclosures

The authors have no conflicts of interest to declare.

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

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