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Transradial vs Transfemoral Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A
Sukhchain Singh1, Mukesh Singh2, Navsheen Grewal3
1Department of Hospital Medicine at Ingalls Memorial Hospital, Harvey, Illinois, USA; Department of Cardiovascular Medicine at Mount Sinai Medical Center, Chicago, Illinois, USA.
Insights
The transradial approach for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) significantly reduces mortality and bleeding events compared to the transfemoral approach. This meta-analysis confirms its safety and efficacy for STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Percutaneous coronary intervention (PCI) is a primary treatment for STEMI.
- Vascular access site choice (transradial vs. transfemoral) impacts PCI outcomes.
Purpose of the Study:
- To conduct a meta-analysis evaluating the safety and efficacy of the transradial versus transfemoral approach for primary PCI in STEMI patients.
- To compare key clinical outcomes between the two vascular access methods.
Main Methods:
- Systematic search of randomized controlled trials comparing transradial and transfemoral approaches in STEMI patients undergoing PCI.
- Inclusion of studies from major databases: PubMed, Embase, CENTRAL, CINAHL, and clinicaltrials.gov.
- Application of random effect models to pool effect sizes for various outcome measures.
Main Results:
- Sixteen trials with 9726 patients showed transradial PCI significantly reduced all-cause mortality, major bleeding, access site bleeding, MACE, and hospital stay.
- Transradial approach demonstrated a 32.8% reduction in mortality and 48.1% in major bleeding.
- Stroke incidence was numerically higher with transradial but not statistically significant; heterogeneity was low.
Conclusions:
- The transradial approach is superior to the transfemoral approach for primary PCI in STEMI patients.
- Transradial PCI significantly lowers mortality, bleeding complications, and hospital length of stay.
- The transradial approach offers a safer and more effective strategy for STEMI management.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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