title: Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non-ST-Segment Elevation Acute Coronary Syndrome.
abstract: Radial access for percutaneous coronary intervention (PCI) has been shown to reduce mortality and vascular complications compared to femoral access in patients with ST-segment elevation myocardial infarction. However, efficacy and safety of radial access PCI in non-ST-segment elevation acute coronary syndrome (NSTE ACS) is not well understood. A systematic search of electronic databases was performed through July 2015 to search and identify relevant studies. We evaluated the following short-term outcomes: all-cause mortality, major bleeding, access site bleeding, and need for blood transfusions. In addition, we evaluated 1-year mortality. Studies were pooled using random effects model. Nine studies including a total of 220,126 patients (radial approach: 94,663 patients [43%], femoral approach: 125,463 patients [57%]) were included in the analysis. On pooled analysis, no significant difference in incidence of short-term all-cause mortality was found between radial and femoral access (odds ratio [OR] 0.78, 95% CI 0.57 to 1.07, p = 0.12). Radial access was associated with significant reduction in major bleeding (OR 0.52, 95% CI 0.36 to 0.73, p = 0.0002), access-site bleeding (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007), and need for blood transfusions (OR 0.61, 95% CI 0.41 to 0.91, p = 0.02). Furthermore, the 1-year mortality was significantly lower in radial approach (OR 0.72, 95% CI 0.55 to 0.95, p = 0.02). In conclusion, in patients with non-ST-segment elevation acute coronary syndrome undergoing PCI, radial access is associated with decreased bleeding and access-site complications.
authors.affiliation: Department of Cardiology, Mount Sinai St. Luke's & West Hospitals, New York, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Sadik R
authors.initials: SR
authors.lastname: Panwar
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Nitin
authors.initials: N
authors.lastname: Barman
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Choudhury M
authors.initials: CM
authors.lastname: Hasan
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York. Electronic address: samin.sharma@mountsinai.org.
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000379:methods*; D004562:Electrocardiography; D005263:Femoral Artery; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D016896:Treatment Outcome