Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials.
BACKGROUND
Although transfemoral access (TFA) remains the standard of care for patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) in the USA, TRA is being increasingly used over TFA due to lower bleeding and mortality rates on the basis of meta-analyses and recently published MATRIX trial. In patients with unsuccessful ipsilateral radial access, TUA has been used as an alternative approach. The randomized controlled trials (RCTs) comparing TUA and TRA have reached mixed conclusions regarding the use of transulnar approach for coronary procedures.


OBJECTIVE
To systematically review and perform a meta-analysis of published RCTs comparing the safety and efficacy of transulnar access (TUA) vs. transradial access (TRA) in patients undergoing CA or PCI.


METHODS
PubMed, EMBASE, and CENTRAL databases were searched for RCTs since inception through December, 2014. Meta-analysis was performed using random-effects model.


RESULTS
Five RCTs involving 2,744 total patients were included in the meta-analysis. TUA compared with TRA had similar risks of MACE [risk ratio (RR): 0.87; 95% confidence interval (CI): 0.56-1.36; P = 0.54] and access-related complications [RR: 0.92 (0.67-1.27); P = 0.62]. Higher rates of access cross-over [RR: 2.31 (1.07-4.98); P = 0.003] and number of punctures [1.57 vs. 1.4; mean difference (MD): 0.17; 95% CI: 0.08-0.26; P = 0.0002] were noted with TUA. There was no difference in arterial access time [12.8 vs. 10.9 min; MD: 1.86 (-1.35-5.7); P = 0.26], fluoroscopy time [7.6 vs. 7.2 min; MD: 0.37 (-0.39 - 1.13); P = 0.34] and contrast volume [151 vs. 153.7 ml; MD: -2.74 (-17.21 - 11.73); P = 0.71].


CONCLUSIONS
For patients requiring CA or PCI, TUA compared with TRA has similar efficacy and safety except for higher puncture rates and access cross-over.
Department of Medicine, LRGHealthcare, Laconia, New Hampshire.
Khagendra
K
Dahal
Department of Medicine, Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
Jharendra
J
Rijal
Division of Cardiology, Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, Connecticut.
Juyong
J
Lee
Division of Cardiology, Miriam Hospital, Alpert Medical School of Brown University Providence, Rhode Island.
Kenneth S
KS
Korr
Division of Cardiology, Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, Connecticut.
Michael
M
Azrin
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging
PCI; access cross-over; access-related complications; coronary angiography; coronary artery disease; transradial access; transulnar access