Meta-Analysis of Transradial vs Transfemoral Access for Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction
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.
References (30)
- et al.
Characterization of the average daily ischemic and bleeding risk after primary PCI for STEMI
J Am Coll Cardiol
(2017) - et al.
Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction—the RADIAL-AMI pilot randomized trial
Am Heart J
(2005) - et al.
Effectiveness and feasibility of transradial approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction
J Nanjing Med Univer
(2009) - et al.
ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL Trial
J Am Coll Cardiol
(2014) - et al.
Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial
The Lancet
(2011) - et al.
Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial versus femoral randomized investigation in ST-elevation acute coronary syndrome) Study
J Am Coll Cardiol
(2012) - et al.
Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials
JACC: Cardiovascular Interventions
(2016) - et al.
Transradial vs transfemoral percutaneous coronary intervention in ST-segment elevation myocardial infarction: a systemic review and meta-analysis
Can J Cardiol
(2016) - et al.
The prevalence and outcomes of transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction: analysis from the national cardiovascular data registry (2007 to 2011)
J Am Coll Cardiol
(2013) - et al.
Variation in the adoption of transradial access for ST-segment elevation myocardial infarction: insights from the NCDR CathPCI Registry
JACC: Cardiovasc Interv
(2017)
An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the national cardiovascular data registry CathPCI Registry
JACC: Cardiovasc Interv
Evaluation of the ;learning curve; for left and right radial approach during percutaneous coronary procedures
Am J Cardiol
Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison
Am Heart J
2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention and the 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction
Circulation
Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial
Cath Cardiovasc Interv
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