title: Meta-Analysis of Radial Versus Femoral Artery Approach for Coronary Procedures in Patients With Previous Coronary Artery Bypass Grafting.
abstract: Cardiac catheterization through the radial artery approach (RA) has been shown to significantly reduce access-site complications compared with the femoral artery approach (FA) in many clinical settings. However, in the subset of patients with previous coronary artery bypass grafting (CABG), optimal vascular access site for coronary angiography and intervention is still a matter of debate. We aimed to perform a systematic review and meta-analysis of available studies comparing RA with FA in patients with previous CABG. Data were extracted by two independent reviewers; weighted mean differences and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. Summary statistics were calculated by random-effects model using Review Manager 5.3 software. The meta-analysis included 1 randomized and 8 nonrandomized studies, with a total of 2,763 patients. Compared with FA, RA required similar procedural time (mean difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time (mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p = 0.75) and was associated with similar rate of procedural failure (OR 1.32, 95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In conclusion, the present meta-analysis suggests that in patients with previous CABG undergoing coronary procedures, RA, compared with FA, is associated with increased crossover rate but may reduce access-site complications.
authors.affiliation: Emergency Department, Sandro Pertini Hospital, Rome, Italy. Electronic address: stefanorigattieri@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.affiliation: Emergency Department, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Department of Cardiology, Frimley Park Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rathore
authors.affiliation: Emergency Department, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Francesco R
authors.initials: FR
authors.lastname: Pugliese
authors.affiliation: Emergency Department, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Fedele
authors.affiliation: Department of Cardiology, AHEPA Hospital, Thessaloniki, Greece.
authors.forename: Antonios G
authors.initials: AG
authors.lastname: Ziakas
authors.affiliation: Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yu J
authors.initials: YJ
authors.lastname: Zhou
authors.affiliation: University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Guzman
authors.affiliation: University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005263:Femoral Artery; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D012086:Reoperation