The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis

Abstract

Aims: There is an increasing amount of data suggesting that transradial approach is associated with lower incidence of complications in vascular access site and improved clinical outcomes compared with transfemoral approach in the setting of ST-segment elevation myocardial infarction (STEMI). The objective of this study was to assess the safety and efficacy of radial versus femoral percutaneous coronary intervention (PCI) for patients with STEMI.

Methods and results: We searched MEDLINE, EMBASE, and Cochrane databases for randomised, case-control, and cohort studies comparing access-related complications and clinical outcomes from January 2001 to October 2011. Twenty-one studies involving 8,534 patients were identified. Transradial approach was associated with a significant reductions in major adverse cardiac events (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.72, p<0.001), mortality (OR 0.55, 95% CI 0.42-0.72, p<0.001), and major bleeding (OR 0.32, 95% CI 0.22-0.48, p<0.001) compared to transfemoral approach. There was a shorter hospital length of stay with transradial access with a weighted mean difference of 2.23 days (95% CI -3.32--1.14, p<0.001) compared to transfemoral access. There were no differences in fluoroscopic time, door-to-balloon time, and procedure time between the two access routes (p=0.09, p=0.38, p=0.82, respectively). The rate of access site crossover tended to be higher with transradial access (p=0.06).

Conclusions: This updated meta-analysis demonstrates that transradial PCI reduces the risk of significant periprocedural bleeding and improve clinical outcomes in patients with STEMI.