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Meta-Analysis
. 2015 Aug;48(8):743-50.
doi: 10.1590/1414-431X20154571. Epub 2015 Jun 23.

Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

S L Xia  1 , X B Zhang  1 , J S Zhou  1 , X Gao  1
Affiliations
Meta-Analysis

Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

S L Xia et al. Braz J Med Biol Res. 2015 Aug.

Abstract

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

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Figures

Figure 1
Figure 1. Flowchart of study selection.
Figure 2
Figure 2. Meta-analyses of primary outcomes. A, Comparison of the left radial approach (LRA) versus the right radial approach (RRA) for procedural failure. B, Comparison of the LRA versus the RRA for fluoroscopy time. In the study of Sciahbasi (13), we reported the meta-analysis results of percutaneous coronary intervention (PCI) and diagnostic angiography (Angio). See Table 1 for numbers of all references cited.
Figure 3
Figure 3. Meta-analysis of secondary outcomes. A, Comparison of the left radial approach (LRA) versus the right radial approach (RRA) for contrast volume. B, Comparison of the LRA versus the RRA for procedural time. In the study of Sciahbasi (13), we reported the meta-analysis results of percutaneous coronary intervention (PCI) and diagnostic angiography (Angio). See Table 1 for numbers of all references cited.
Figure 4
Figure 4. Meta-analysis of subclavian tortuosity and catheter count. A, Comparison of the left radial approach (LRA) versus the right radial approach (RRA) for tortuosity of the subclavian artery. B, Comparison of the LRA versus the RRA for catheter count. C, Sensitivity analysis of the catheter count meta-analysis excluding the studies by Kanei and Louvard (30,31). See Table 1 for numbers of all references cited.
Figure 5
Figure 5. Funnel plot assessment of publication bias.
See this image and copyright information in PMC

References

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