Coronary artery disease
Meta-Analysis of Ten Trials on the Effectiveness of the Radial Versus the Femoral Approach in Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2011.11.007Get rights and content

The radial approach in primary percutaneous coronary intervention (PCI) has been recently assessed in both randomized and observational studies. However, observational studies have several biases that favor the radial approach. We conducted a meta-analysis of randomized controlled trials to compare the clinical outcomes of radial and femoral approach in primary PCI for ST-segment elevation myocardial infarction. The outcomes of interest included death, major bleeding, vascular complications/hematoma, and procedure time. The data were pooled using random-effects models. Ten randomized controlled trials involving 3,347 patients met our inclusion criteria. The radial approach was associated with improved survival (odds ratio 0.53, 95% confidence interval 0.33–0.84) and reduced vascular complications/hematoma (odds ratio 0.35, 95% confidence interval 0.24–0.53). A nonsignificant trend was found toward reduced major bleeding with the radial approach (odds ratio 0.63, 95% confidence interval 0.35–1.12). The procedural time with the radial approach was longer by <2 minutes (mean difference 1.76 minutes, 95% confidence interval 0.59–2.92). In conclusion, in patients undergoing primary PCI, the radial approach is associated with lower short-term mortality. When feasible, the radial approach should be the favored route in primary PCI.

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Methods

We performed a systematic review and meta-analysis in accordance with the standards set forth by the Quality of Reporting of Meta-Analyses statement.4 We searched PubMed, EMBASE, Web of Science, and the Cochrane Library (from inception through June 2011). We used the following keywords: “radial,” “transradial,” “percutaneous coronary intervention,” “primary PCI,” and “acute myocardial infarction.” We limited our search to the English language. In addition, we hand-searched the references of the

Results

Ten studies were found to meet our inclusion criteria. Figure 1 shows the flow diagram leading to our study selection. The selected studies encompassed 3,347 patients, randomized from 2,003 and 2,011. The baseline characteristics of the studied population are summarized in Table 1. Nine studies exclusively enrolled patients with STEMI.5, 6, 7, 8, 9, 10, 11, 12, 13 One study (radial versus femoral access for coronary intervention [RIVAL]) enrolled patients with acute coronary syndrome, of whom

Discussion

In the present meta-analysis, we found a significant early mortality benefit using the radial approach in primary PCI. A trend was seen toward less major bleeding. The incidence of vascular complications or hematoma was significantly reduced. Despite the challenges inherent to the radial approach in this patient population, the procedure time was only modestly increased.

The present study is the first meta-analysis from randomized data concerning the access approach in this STEMI population. A

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Dr. Eisenberg is a Chercheur-National and Drs. Bertrand and Rinfret are Junior Physician-Scientists of the Fonds de la Recherche en Santé du Québec.

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