title: Transradial vs Transfemoral Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Systemic Review and Meta-analysis.
abstract: The objective of this meta-analysis to evaluate safety and efficacy of transradial vs the transfemoral approach for primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients.
  
  
  
  Randomized controlled trials that compared the transfemoral vs the transradial approach in STEMI patients who underwent PCI were searched in PubMed, Embase, CENTRAL, Cumulative Index to Nursing and Allied Health Literature, and clinicaltrials.gov. Random effect models were used to pool effect sizes.
  
  
  
  Sixteen trials, comprising data from 9726 patients, were included in the meta-analysis. All-cause mortality (risk ratio [RR], 0.68; 95% confidence interval [CI], 0.54-0.85; relative risk reduction [RRR], 32.8%; I(2) = 0), major bleeding (RR 0.56; 95% CI, 0.42-0.74; RRR, 48.1%; I(2) = 0), access site bleeding (RR, 0.38; 95% CI, 0.29-0.50; RRR, 63.9%; I(2) = 0), major adverse cardiovascular events (RR, 0.80; 95% CI, 0.68-0.94; RRR, 19.3%; I(2) = 0), and length of hospital stay (standardized mean difference, -0.38 days; 95% CI, -0.46 to -0.31 days) were significantly lower with the transradial compared with the transfemoral approach. The greatest reduction in major bleeding was found in the subgroup with trials recruiting only primary PCI participants compared with varying proportions of rescue PCIs. Glycoprotein IIb/IIIa inhibitor use and cross-over rates did not have a significant association with outcome measures in the subgroup analysis. Incidence of stroke was numerically greater with the transradial approach but did not achieve statistical significance (RR, 1.22; 95% CI, 0.56-2.66; I(2) = 0). Overall statistical heterogeneity (I(2)) was very low except for length of hospital stay.
  
  
  
  The transradial approach for PCI in STEMI patients significantly reduced all-cause mortality, major and access site bleeding, major adverse cardiovascular events, and length of hospital stay. Difference in stroke incidence was not statistically significant with the transradial vs the transfemoral approach.
authors.affiliation: Department of Hospital Medicine at Ingalls Memorial Hospital, Harvey, Illinois, USA; Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA. Electronic address: s.singhmd@outlook.com.
authors.forename: Sukhchain
authors.initials: S
authors.lastname: Singh
authors.affiliation: Chicago Medical School, North Chicago, Illinois, USA.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA; School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Navsheen
authors.initials: N
authors.lastname: Grewal
authors.affiliation: Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA; Department of Cardiovascular Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D017534:Radial Artery; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects