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

Aravdeep Jhand, Varunsiri Atti, Yeongjin Gwon, Rahul Dhawan, Mohit K. Turagam, Mamas A. Mamas, Emmanouil S. Brilakis, Arnav Kumar, Natraj Katta, Yiannis Chatzizisis, Manish Parikh, J. Dawn Abbott, Ajay J. Kirtane, Deepak L. Bhatt, Poonam Velagapudi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalAmerican Journal of Cardiology
Volume141
DOIs
StatePublished - Feb 15 2021

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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