COMPARISON OF TRANSRADIAL VERSUS TRANSFEMORAL ACCESS FOR PERCUTANEOUS CORONARY INTERVENTION IN STEMI PATIENTS: A META-ANALYSIS OF RANDOMIZED TRIALS

Jhand, Aravdeep; Atti, Varunsiri; Dhawan, Rahul; Turagam, Mohit; Mamas, Mamas A.; Brilakis, Emmanouil; Kumar, Arnav; Katta, Natraj; Chatzizisis, Yiannis S.; Abbott, J.; Kirtane, Ajay; Bhatt, Deepak; Velagapudi, Poonam

Abstract

Background
Transradial access (TRA) is increasingly being used for percutaneous coronary intervention (PCI) in ST- segment elevation myocardial infarction (STEMI) in lieu of transfemoral access (TFA). We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of the two approaches in STEMI-PCI.

Methods
PubMed, Cochrane, Embase databases and major national conference proceedings were systematically searched for RCTs comparing TRA and TFA in patients undergoing PCI for STEMI. Efficacy outcomes studied were all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and stroke. Safety outcomes included major bleeding and vascular complications. Risk ratios (RR) and 95 % Confidence Intervals (CI) were calculated using random effects model.

Results
17 trials met our inclusion criteria with a total of 12018 patients (TRA: 5958 and TFA: 6060). At a mean follow-up of 4.8 +/- 8.2 months, rates of all-cause mortality (RR: 0.71, 95% CI = 0.57 - 0.88), major bleeding (RR: 0.59, 95% CI = 0.45 - 0.77), and vascular complications (RR: 0.42, 95% CI = 0.32 - 0.56) were lower in TRA compared with TFA (Figure 1), while there was no difference in rates of MACE, MI, or stroke between groups. Hospital length of stay was lower in the TRA group.

Conclusion
TRA is associated with better short-term survival and lower rates of major bleeding and vascular complications compared with TFA in STEMI patients undergoing PCI.

Citation

Jhand, A., Atti, V., Dhawan, R., Turagam, M., Mamas, M. A., Brilakis, E., Kumar, A., Katta, N., Chatzizisis, Y. S., Abbott, J., Kirtane, A., Bhatt, D., & Velagapudi, P. (2020). COMPARISON OF TRANSRADIAL VERSUS TRANSFEMORAL ACCESS FOR PERCUTANEOUS CORONARY INTERVENTION IN STEMI PATIENTS: A META-ANALYSIS OF RANDOMIZED TRIALS. Journal of the American College of Cardiology, 75(11), 1281. https://doi.org/10.1016/s0735-1097%2820%2931908-2

• Journal Article Type: Article
• Online Publication Date: Mar 24, 2020
• Publication Date: 2020-03
• Deposit Date: Jun 21, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Electronic ISSN: 1558-3597
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: 11
• Pages: 1281
• DOI: https://doi.org/10.1016/s0735-1097%2820%2931908-2
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://keele-repository.worktribe.com/output/491202