title: Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis.
abstract: BACKGROUND
  Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI.
  
  
  METHODS
  Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI.
  
  
  RESULTS
  We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials.
  
  
  CONCLUSIONS
  Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada. olivier.bertrand@criucpq.ulaval.ca
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Patrick
authors.initials: P
authors.lastname: Bélisle
authors.forename: Dominique
authors.initials: D
authors.lastname: Joyal
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
authors.forename: David
authors.initials: D
authors.lastname: Meerkin
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome