Elsevier

The American Journal of Cardiology

Volume 141, 15 February 2021, Pages 23-30
The American Journal of Cardiology

Meta-Analysis of Transradial vs Transfemoral Access for Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2020.11.016Get rights and content

Transradial access (TRA) has emerged as an alternative to transfemoral access (TFA) for percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) patients. However, the rate of TRA adoption has been much slower in the acute coronary syndrome (ACS) patient population. This meta-analysis was conducted to assess clinical outcomes of TRA compared with TFA in STEMI patients undergoing PCI. A manual search of PubMed, EMBASE, Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and recent major scientific conference sessions from inception to October 15th, 2019 was performed. Primary outcomes in our analysis were all-cause mortality and trial-defined major bleeding. Secondary outcomes included vascular complications, myocardial infarction, stroke, procedure, and fluoroscopy time. 17 randomized controlled trials (RCTs) (N = 12,018) met inclusion criteria. TRA was associated with lower all-cause mortality (risk ratio [RR]: 0.71, 95% confidence interval [CI]: 0.57 to 0.88), major bleeding (RR: 0.59, 95%CI: 0.45 to 0.77), and vascular complications (RR: 0.42, 95%CI: 0.32 to 0.56) compared with TFA. There was no difference in the incidence of myocardial infarction (MI), stroke, or procedure duration between the 2 groups. The difference in all-cause mortality between TRA and TFA was statistically nonsignificant when major bleeding was held constant. In conclusion, TRA was associated with lower risk of all-cause mortality, major bleeding, and vascular complications compared with TFA in STEMI patients undergoing PCI.

Section snippets

Methods

The systematic review and meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.20 The initial search strategy was developed by 2 authors (AJ and RD). A systematic search, without language restriction was performed in PubMed, EMBASE, Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ClinicalTrials.gov from inception to October 15th, 2019 for studies comparing TRA versus

Results

A total of 990 articles were identified through database search. After excluding duplicates and studies that did not meet inclusion criteria, a total of 17 RCTs comparing TRA and TFA in STEMI-PCI were selected for the quantitative analysis (Figure 1).

This meta-analysis included 17 RCTs with 12,018 patients, of which 5,958 underwent PCI using TRA and 6,060 using TFA in STEMI.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16,19,21, 22, 23 Mean/median age of study population ranged from 52 to 71.4

Discussion

In this meta-analysis of 17 RCTs evaluating 12,018 patients randomized to TRA versus TFA for PCI in STEMI, TRA was associated with a 29% lower risk of all-cause mortality, 58% lower risk of vascular complications and 41% lower risk of trial-defined major bleeding. There was no difference in stroke, MI, or procedure duration between the 2 access sites. Meta-regression demonstrated that the difference in all-cause mortality between TRA and TFA became statistically nonsignificant when major

Disclosures

Aravdeep Jhand: None.

Varunsiri Atti: None.

Rahul Dhawan: None.

Yeongjin Gwon: None.

Mohit Turagam: None.

Mamas Mamas: None.

Emmanouil Brilakis: Consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures.

Arnav Kumar:

Contributorship Statement

Aravdeep Jhand, Varunsiri Atti and Poonam Velagapudi were involved in planning, conduct, and reporting the described work.

Rest of the authors were involved in reviewing the manuscript and providing critical feedback.

Ethics Committee Approval

The study is exempted from IRB approval as it involves study level data from previous publications.

Reporting Patient and Public Involvement in Research

No patients were involved for this research.

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.

Acknowledgment

We thank Kimberly A Harp, MLS; Education and Research Services Librarian, Assistant Professor, McGoogan Library of Medicine, University of Nebraska Medical Center for her assistance with the review of literature search for this meta-analysis.

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