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. 2015 Oct 15;8(10):17151-66.
eCollection 2015.

Radial versus femoral artery access for percutaneous coronary angiography and intervention: a systematic review and meta-analysis of randomized controlled trials in Chinese population

Peng Liu  1 , Xue Liang Gao  1 , Bei Fang Li  1 , Xue Zhi Ding  1 , Zi Hao Wang  1 , Yan Ping Dang  1 , Yang Gui Liu  1 , Yun Fu Li  1
Affiliations

Radial versus femoral artery access for percutaneous coronary angiography and intervention: a systematic review and meta-analysis of randomized controlled trials in Chinese population

Peng Liu et al. Int J Clin Exp Med. .

Abstract

To compare the feasibility, efficiency and safety of coronary angiography (CAG) and interventional procedures between the radial and femoral catheterization approaches in Chinese population using systematic review and meta-analysis, we conducted a search of the studies comparing radial and femoral catheterization approaches in patients underwent either CAG or percutaneous coronary intervention (PCI) in Chinese population. Fixed-effect relative risk (RR) for the primary end points and the second end points were compared between the two approaches. A total of 27 studies (n=8,749 patients) were finally included in the analysis. The success rate of radial approach was slightly lower than that of femoral approach in patients receiving CAG (P=0.004), but similar in patients receiving a further PCI treatment (P=0.11). The risk of major adverse cardiovascular events (MACEs) was similar between two approaches (P=0.27). Radial catheterization had a significantly lower rate of puncture site complications (P<0.00001), but a lower rate of puncture success rate (P=0.02). In patients with acute myocardial infarction (AMI), there was no difference in neither the risk of MACEs nor PCI success rate between two approaches (P=0.23 and 0.45, respectively), but a board line decrease of puncture success rate was observed in radial catheterization group (P=0.04). There were no significant differences in the volumes of contrast media, X-ray exposure time and operation time between the two approaches (all P>0.05). Thus, we concluded that radial approach is a safe method for CAG or PCI compared to traditional femoral approach in Chinese population due to their similar success rate of the procedure and risk of MACEs, and a decreased risk of puncture site complications.

Keywords: Radial artery; acute myocardial infarction (AMI); coronary angiography (CAG); coronary disease; femoral artery; meta-analysis; percutaneous coronary intervention (PCI); systematic review.

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Figures

Figure 1
Figure 1
Forest plot comparing success rate of CAG between radial and femoral approaches in 5 studies of patients with CAD. RRs and 95% confidence intervals are shown for individual studies and the pooled population.
Figure 2
Figure 2
Comparison of success rate of PCI between radial and femoral approaches in 16 studies of patients with CAD. A. Forest plot. RRs and 95% confidence intervals are presented for individual studies and the pooled population. B. Funnel plot of heterogeneity analysis.
Figure 3
Figure 3
Forest plot comparing major adverse cardiac events (MACEs) between radial and femoral approaches in 9 studies of patients with CAD. RRs and 95% confidence intervals are shown for individual studies and the pooled population.
Figure 4
Figure 4
Comparison of puncture site complications between radial and femoral approaches in 27 studies of patients with CAD. A. Forest plot. RRs and 95% confidence intervals are shown for individual studies and the pooled population. B. Funnel plot of heterogeneity analysis.
Figure 5
Figure 5
Comparison of puncture success rate between radial and femoral approaches in 15 studies of patients with CAD. A. Forest plot. RRs and 95% confidence intervals are presented for individual studies and the pooled population. B. Funnel plot of heterogeneity analysis.
Figure 6
Figure 6
Comparison of PCI success rate between radial and femoral approaches in 12 studies of patients with AMI. A. Forest plot. RRs and 95% confidence intervals are presented for individual studies and the pooled population. B. Funnel plot of heterogeneity analysis.
Figure 7
Figure 7
Forest plot comparing major adverse cardiac events (MACEs) between radial and femoral approaches in 7 studies of patients with AMI. RRs and 95% confidence intervals are presented for individual studies and the pooled population.
Figure 8
Figure 8
Comparison of puncture site complications between radial and femoral approaches in 13 studies of patients with AMI. A. Forest plot. RRs and 95% confidence intervals are presented for individual studies and the pooled population. B. Funnel plot of heterogeneity analysis.
Figure 9
Figure 9
Forest plot comparing puncture success rate between radial and femoral approaches in 9 studies of patients with AMI. RRs and 95% confidence intervals are presented for individual studies and the pooled population.
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