title: Safety and efficacy of transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction:  a meta-analysis of randomized trials.
abstract: BACKGROUND
  The transradial approach has gained increasing popularity for elective percutaneous coronary intervention. However, the safety and feasibility of transradial coronary intervention (TRI) in acute myocardial infarction (AMI) remains uncertain. Hence, a meta-analysis of randomized trials was performed to compare outcomes of TRI with transfemoral coronary intervention (TFI) in patients with AMI.
  
  
  METHODS
  A systematic review of the literature revealed seven randomized trials involving 1306 patients. Endpoints extracted were access site complications, major adverse cardiovascular events, major bleeding, and procedural success. Combined relative risks (RRs) across all studies and 95% confidence intervals (CIs) were computed. A two-sided α error of less than 0.05 was considered to be statistically significant.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. Compared with patients undergoing TFI, risk of major adverse cardiovascular events (RR: 0.83, CI: 0.51-1.35; P=0.45) and major bleeding (RR: 0.51, CI: 0.20-1.26; P=0.14) was similar in patients undergoing TRI. The procedural success was similar with both approaches (RR: 0.99, CI: 0.96-1.02; P=0.59). However, incidence of access site complications was significantly lower in the TRI group (RR: 0.31, CI: 0.17-0.58; P<0.001).
  
  
  CONCLUSIONS
  The meta-analysis suggests that TRI may be superior to TFI in reducing access site complications in patients with AMI. However, there is no difference in procedural success and major bleeding between the two groups.
authors.affiliation: Department of Cardiology, Chicago Medical School, North Chicago, Illinois, USA.
authors.forename: Param P
authors.initials: PP
authors.lastname: Singh
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.forename: Natalia
authors.initials: N
authors.lastname: Khosla
authors.forename: Tejaskumar
authors.initials: T
authors.lastname: Shah
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016896:Treatment Outcome