title: The fluoroscopy time, door to balloon time, contrast volume use and prevalence of vascular access site failure with transradial versus transfemoral approach in ST segment elevation myocardial infarction: A systematic review & meta-analysis.
abstract: OBJECTIVE
  The authors aimed to conduct first systematic review and meta-analysis in STEMI patients evaluating vascular access site failure rate, fluoroscopy time, door to balloon time and contrast volume used with transradial vs transfemoral approach (TRA vs TFA) for PCI.
  
  
  METHODS
  The PubMed, CINAHL, clinicaltrials.gov, Embase and CENTRAL databases were searched for randomized trials comparing TRA versus TFA. Random effect models were used to conduct this meta-analysis.
  
  
  RESULTS
  Fourteen randomized trials comprising 3758 patients met inclusion criteria. The access site failure rate was significantly higher TRA compared to TFA (RR 3.30, CI 2.16-5.03; P=0.000). Random effect inverse variance weighted prevalence rate meta-analysis showed that access site failure rate was predicted to be 4% (95% CI 3.0-6.0%) with TRA versus 1% (95% CI 0.0-1.0 %) with TFA. Door to balloon time (Standardized mean difference [SMD] 0.30 min, 95% CI 0.23-0.37 min; P=0.000) and fluoroscopy time (Standardized mean difference 0.14 min, 95% CI 0.06-0.23 min; P=0.001) were also significantly higher in TRA. There was no difference in the amount of contrast volume used with TRA versus TFA (SMD -0.05 ml, 95% CI -0.14 to 0.04 ml; P=0.275). Statistical heterogeneity was low in cross-over rate and contrast volume use, moderate in fluoroscopy time but high in the door to balloon time comparison.
  
  
  CONCLUSIONS
  Operators need to consider higher cross-over rate with TRA compared to TFA in STEMI patients while attempting PCI. Fluoroscopy and door to balloon times are negligibly higher with TRA but there is no difference in terms of contrast volume use.
authors.affiliation: Department of Hospital Medicine at Ingalls Memorial Hospital, Harvey, Illinois; Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois. Electronic address: s.singhmd@outlook.com.
authors.forename: Sukhchain
authors.initials: S
authors.lastname: Singh
authors.affiliation: Chicago Medical School, North Chicago, Illinois.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois; School of Public Health, University of Illinois at Chicago, Illinois.
authors.forename: Navsheen
authors.initials: N
authors.lastname: Grewal
authors.affiliation: Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois; Department of Cardiovascular Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D003287:Contrast Media; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017534:Radial Artery; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment; D017211:Treatment Failure; D062666:Vascular Access Devices / Q000009:adverse effects*
chemical_list: D003287:Contrast Media
keywords: Coronary interventions; ST-segment elevation; Transfemoral; Transradial