Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis

ABSTRACT

Background

Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial.

Methods

PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model.

Results

We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49–0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32–0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43–0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43–0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49–0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44–0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year.

Conclusion

TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.

KEYWORDS:

• Percutaneous coronary intervention
• st-elevation myocardial infarction
• transradial
• transfemoral

Author Contribution

Conceptualization: YS, WU, and MCA; Methodology: YS, MM, AK; Data curation: UD, SR, SM; Formal analysis: YS, MM; Original draft: YS, SM, HMP, FD, MZ, and MS; Writing, review & editing. MZ, ZK, RB, PK, NI, AP, ARS, MCA; Journal Formatting: SB and MZ

*Dr. Sattar and Majmundar contributed equally to this manuscript as co-first authors

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Highlights

• Transradial percutaneous coronary intervention have a better survival benefit and lower complications, including major bleeding and major adverse cardiac events in STEMI population as compared with transfemoral approach during short in-hospital to 30 days follow-up.

• The long-term outcomes of clinical efficacy and safety are superior for transradial percutaneous coronary intervention as compared with transfemoral approach for STEMI population.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.