title: Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  A meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI).
  
  
  METHODS
  A Medline and Embase search was conducted using the search terms 'transradial,' 'radial', 'STEMI', 'myocardial' and 'infarction'.
  
  
  METHODS
  Randomised controlled studies that compare outcomes of transradial versus the transfemoral route.
  
  
  METHODS
  A total of nine studies were identified that consisted of 2977 patients with STEMI. Interventions Studies that compare outcomes of transradial versus the transfemoral route.
  
  
  METHODS
  The primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications.
  
  
  RESULTS
  Transradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p=0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p=0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.
authors.affiliation: Clinical Lecturer in Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9PT, UK. mamasmamas1@yahoo.co.uk
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.forename: Helen
authors.initials: H
authors.lastname: Routledge
authors.forename: Farzin
authors.initials: F
authors.lastname: Fath-Ordoubadi
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fraser
authors.forename: Jim
authors.initials: J
authors.lastname: Nolan
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000628:therapy*; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology