Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials

Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies w...

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Published in:PloS one 2014-05, Vol.9 (5), p.e96127-e96127
Main Authors: Piccolo, Raffaele, Galasso, Gennaro, Capuano, Ernesto, De Luca, Stefania, Esposito, Giovanni, Trimarco, Bruno, Piscione, Federico
Format: Article
Language:English
Subjects:
Access control
Acute Coronary Syndrome - surgery
Acute coronary syndromes
Analysis
Angioplasty
Balloon angioplasty
Bias
Bleeding
Cardiac patients
Cardiology
Catheterization
Clinical trials
Complications
Confidence intervals
Coronary heart disease
Death
Electrocardiography
Female
Femoral Artery - surgery
Health aspects
Heart attacks
Heart diseases
Humans
Intervention
Intubation
Male
Medicine and Health Sciences
Meta-analysis
Mortality
Patients
Percutaneous Coronary Intervention - methods
Radial Artery - surgery
Randomization
Randomized Controlled Trials as Topic
Regression analysis
Risk
Sequential analysis
Statistical analysis
Studies
Treatment Outcome
Websites
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cited_by cdi_FETCH-LOGICAL-c692t-457325f7e8e4d1ada59a4ce2cb7845b0827c9b8c4addb19e011a134611db2e233
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Galasso, Gennaro
Capuano, Ernesto
De Luca, Stefania
Esposito, Giovanni
Trimarco, Bruno
Piscione, Federico
description Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed. Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p
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Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p&lt;0.001); these findings were supported by trial sequential analyses. In patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. However, because of the clinical relevance associated with major bleeding and vascular complications reduction, TRA should be recommended as first-choice vascular access in patients with ACS undergoing cardiac catheterization.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24820096</pmid><doi>10.1371/journal.pone.0096127</doi><oa>free_for_read</oa></addata></record>
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1932-6203
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source Publicly Available Content Database; PubMed Central
subjects Access control
Acute Coronary Syndrome - surgery
Acute coronary syndromes
Analysis
Angioplasty
Balloon angioplasty
Bias
Bleeding
Cardiac patients
Cardiology
Catheterization
Clinical trials
Complications
Confidence intervals
Coronary heart disease
Death
Electrocardiography
Female
Femoral Artery - surgery
Health aspects
Heart attacks
Heart diseases
Humans
Intervention
Intubation
Male
Medicine and Health Sciences
Meta-analysis
Mortality
Patients
Percutaneous Coronary Intervention - methods
Radial Artery - surgery
Randomization
Randomized Controlled Trials as Topic
Regression analysis
Risk
Sequential analysis
Statistical analysis
Studies
Treatment Outcome
Websites
title Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-16T21%3A32%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Transradial%20versus%20transfemoral%20approach%20in%20patients%20undergoing%20percutaneous%20coronary%20intervention%20for%20acute%20coronary%20syndrome.%20A%20meta-analysis%20and%20trial%20sequential%20analysis%20of%20randomized%20controlled%20trials&rft.jtitle=PloS%20one&rft.au=Piccolo,%20Raffaele&rft.date=2014-05-12&rft.volume=9&rft.issue=5&rft.spage=e96127&rft.epage=e96127&rft.pages=e96127-e96127&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0096127&rft_dat=%3Cgale_plos_%3EA418552882%3C/gale_plos_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c692t-457325f7e8e4d1ada59a4ce2cb7845b0827c9b8c4addb19e011a134611db2e233%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1523871123&rft_id=info:pmid/24820096&rft_galeid=A418552882&rfr_iscdi=true