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Radial versus femoral access in patients with coronary artery bypass surgery: Frequentist and Bayesian meta-analysis
Ilias Nikolakopoulos1, Evangelia Vemmou1, Iosif Xenogiannis1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
For patients with prior coronary artery bypass surgery (CABG) undergoing cardiac catheterization, radial access offers fewer complications and less contrast volume but has a higher crossover rate compared to femoral access.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The optimal vascular access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) remains a subject of debate.
- Choosing the right access site is crucial for patient outcomes and procedural success.
Purpose of the Study:
- To compare the safety and efficacy of radial versus femoral access for cardiac catheterization in patients with a history of CABG.
- To analyze access-site complications, crossover rates, procedure time, and contrast volume.
Main Methods:
- A meta-analysis was conducted using both frequentist and Bayesian approaches.
- Included 4 randomized trials and 18 observational studies, encompassing 60,192 patients with prior CABG.
- Compared outcomes between radial and femoral access groups, calculating odds ratios and mean differences with 95% confidence intervals.
Main Results:
- Radial access showed a higher crossover rate in both randomized trials (OR: 7.63) and observational studies (OR: 5.09).
- Observational studies indicated lower access-site complication rates (OR: 0.52) and reduced contrast volume (MD: -7.52 ml) with radial access.
- Randomized trials found similar access-site complication rates and contrast volumes between the two groups.
Conclusions:
- Radial access in patients with prior CABG undergoing cardiac catheterization is associated with fewer vascular access complications and lower contrast volume.
- However, radial access also demonstrates a higher rate of crossover to alternative access sites.
- Bayesian analysis suggests minimal differences between radial and femoral access for most outcomes, except for crossover rates.
Background:
The optimal access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) continues to be debated.
Methods:
We performed a random effects frequentist and Bayesian meta-analysis of 4 randomized trials and 18 observational studies, including 60,192 patients with prior CABG (27,236 in the radial group; 32,956 in the femoral group) that underwent cardiac catheterization. Outcomes included (1) access-site complications, (2) crossover to a different vascular access, (3) procedure time, and (4) contrast volume. Mean differences (MD) and 95% confidence interval (CI) were calculated for continuous outcomes and odds ratios (OR) and 95% CI for binary outcomes.
Results:
Among randomized trials, crossover (OR: 7.63; 95% CI: 2.04, 28.51; p = 0.003) was higher in the radial group, while access site complications (OR: 0.96; 95% CI: 0.34, 2.87; p = 0.94) and contrast volume (MD: 15.08; 95% CI: -10.19, 40.35; p = 0.24) were similar. Among observational studies, crossover rates were higher (OR: 5.09; 95% CI: 2.43, 10.65; p < 0.001), while access site complication rates (OR: 0.52; 95% CI: 0.30, 0.89; p = 0.02) and contrast volume (MD: -7.52; 95% CI: -13.14, -1.90 ml; p = 0.009) were lower in the radial group. Bayesian analysis suggested that the odds of a difference existing between radial and femoral are small for all endpoints except crossover to another access site.
Conclusion:
In a frequentist and Bayesian meta-analysis of patients with prior CABG undergoing coronary catheterization, radial access was associated with lower incidence of vascular access complications and lower contrast volume but also higher crossover rate.
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