title: Targeting transradial approach: an updated systematic review and meta-analysis.
abstract: BACKGROUND
  Transradial access (TRA) emerged in the last two decades as a valid alternative to the standard transfemoral access (TFA) for cardiac catheterization and percutaneous coronary intervention (PCI). Due to contrasting results, the penetration and uptake of TRA in real-world clinical practice has been slow and still limited to high experienced center.
  
  
  METHODS
  We performed an updated systematic review and study-level meta-analysis of randomized controlled trials (RCTs) that investigated the efficacy and safety of TRA versus TFA for PCI in patients with ACS. MEDLINE, Scopus, the Cochrane Library, and TCTMD.org were searched for abstracts, manuscripts, and conference reports published until April 31, 2016. The three pre-specified primary endpoints of interest were: all-cause mortality, major bleeding and major adverse cardiac events (MACE), at 30 days of follow-up. Primary analytic approach was according the intention-to-treat principle using inverse variance weighted random effect models.
  
  
  RESULTS
  Study level data from 12 RCTs were extracted and analyzed. TRA compared with TFA in ACS patients undergoing invasive management was associated with a significant reduction in the risk of mortality (RR=0.72; 95% CI: 0.59-0.88; P=0.002), major bleeding (RR 0.48; 95% CI: 0.37-0.61; P<0.00001) and MACE (RR 0.81; 95% CI: 0.69-0.96; P=0.01), with similar procedural rate of success. In addition, TRA was associated with reduced in-hospital length of stay. There were no differences in the risk of stroke, myocardial infarction and target vessel or target lesion revascularization.
  
  
  CONCLUSIONS
  The results of the present study confirm TRA as the preferred routine upfront strategy for ACS patients undergoing PCI.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Institute for Scientific Research, Milan, Italy - chieffo.alaide@hsr.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Furia
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic