Coronary artery diseaseMeta-Analysis of Ten Trials on the Effectiveness of the Radial Versus the Femoral Approach in Primary Percutaneous Coronary Intervention
Section snippets
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.