Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials

Mamas A Mamas, Karim Ratib, Helen Routledge, Farzin Fath-Ordoubadi, Ludwig Neyses, Yves Louvard, Douglas G Fraser, Jim Nolan
Heart 2012, 98 (4): 303-11

OBJECTIVE: A meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI).

DESIGN: A Medline and Embase search was conducted using the search terms 'transradial,' 'radial', 'STEMI', 'myocardial' and 'infarction'.

SETTING: Randomised controlled studies that compare outcomes of transradial versus the transfemoral route.

PATIENTS: A total of nine studies were identified that consisted of 2977 patients with STEMI. Interventions Studies that compare outcomes of transradial versus the transfemoral route.

MAIN OUTCOME MEASURES: The primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications.

RESULTS: Transradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p=0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p=0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route.

CONCLUSIONS: This meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.

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