title: Meta-analysis of randomized trials on access site selection for percutaneous coronary intervention in ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Superior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI.
  
  
  METHODS
  Electronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model.
  
  
  RESULTS
  Twelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38-0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43-0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52-0.86), p = 0.002 respectively).
  
  
  CONCLUSIONS
  Robust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.
authors.affiliation: Heart Institute, University of Pécs, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Komócsi
authors.affiliation: Heart Institute, University of Pécs, Hungary.
authors.forename: Dániel
authors.initials: D
authors.lastname: Aradi
authors.affiliation: Department of Statistics and Econometrics, Faculty of Business and Economics, University of Pécs, Hungary.
authors.forename: Dániel
authors.initials: D
authors.lastname: Kehl
authors.affiliation: Invasive Cardiology Unit, Cardiology Center, University of Szeged, Hungary.
authors.forename: Imre
authors.initials: I
authors.lastname: Ungi
authors.affiliation: Invasive Cardiology Unit, Cardiology Center, University of Szeged, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Thury
authors.affiliation: Heart Institute, University of Pécs, Hungary.
authors.forename: Tünde
authors.initials: T
authors.lastname: Pintér
authors.affiliation: Wegmans Pharmacy, Ithaca, New York, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Di Nicolantonio
authors.affiliation: Heart Institute, University of Pécs, Hungary.
authors.forename: Adrienn
authors.initials: A
authors.lastname: Tornyos
authors.affiliation: Heart Institute, University of Pécs, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Vorobcsuk
keywords: ST-segment elevation myocardial infarction; death; transfemoral; transradial