title: Impact of access site choice on outcomes of patients with cardiogenic shock undergoing percutaneous coronary intervention: A systematic review and meta-analysis.
abstract: BACKGROUND
  The benefit of transradial access (TRA) in patients with cardiogenic shock (CS) is uncertain. We sought to determine the benefits of TRA in patients with CS undergoing coronary angiography/intervention.
  
  
  METHODS
  MEDLINE, Embase, Cochrane Central, and electronic databases were searched for studies that assessed the following: (1) patients with CS who underwent percutaneous coronary intervention (PCI) and (2) the association between choice of arterial access, 30-day all-cause mortality, and 30-day major adverse cardiac and cerebral events (MACCEs) using random-effects model.
  
  
  RESULTS
  From 3,652 retrieved citations, 8 studies involving 8,131 patients with CS undergoing PCI (via TRA: 2,321 patients, via TFA: 5,810 patients) were included. Transradial access was associated with significantly reduced risk for all-cause mortality (unadjusted: risk ratio [RR] 0.60, 95% CI 0.52-0.71, P < .001, I(2) = 29%, 8 included studies; adjusted: RR 0.55, 95% CI 0.46-0.65, P < .001, I(2) = 0%, 6 included studies) and MACCE (unadjusted: RR 0.68, 95% CI 0.63-0.73, P < .001, I(2) = 0%, 6 included studies; adjusted: RR 0.63, 95% CI 0.52-0.75, P < .001, I(2) = 0%, 4 included studies) at 30 days when compared with TFA.
  
  
  CONCLUSIONS
  Transradial access is associated with reduced mortality and MACCE at 30 days in patients with CS undergoing PCI. Considering the possible influence of selection bias on the effect estimate in our analysis, randomized controlled trials are needed to better assess this association.
authors: The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, PA. Electronic address: pancholys@gmail.com.
authors: Samir B
authors: SB
authors: Pancholy
authors: The Wright Center for Graduate Medical Education, Scranton, PA.
authors: Ghanshyam
authors: G
authors: Palamaner Subash Shantha
authors: Interventional Cardiology Unit, Ospedale Belcolle, Viterbo, Italy.
authors: Enrico
authors: E
authors: Romagnoli
authors: University Clinic of Cardiology, Skopje, Macedonia.
authors: Sasko
authors: S
authors: Kedev
authors: University Hospital and Faculty of Medicine, Pilsen, Czech Republic.
authors: Ivo
authors: I
authors: Bernat
authors: The Duke Clinical Research Institute, Durham, NC.
authors: Sunil V
authors: SV
authors: Rao
authors: Population Health Research Institute, Hamilton, Ontario, Canada.
authors: Sanjit
authors: S
authors: Jolly
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Olivier F
authors: OF
authors: Bertrand
authors: Apex Heart Institute, Ahmedabad, India.
authors: Tejas M
authors: TM
authors: Patel
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D014943:Global Health; D006801:Humans; D062645:Percutaneous Coronary Intervention; D017534:Radial Artery; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends