Transradial versus transfemoral approach for percutaneous coronary intervention of chronic total occlusions: A meta-analysis and meta-regression
Alrayes H, Villablanca P, Fram G, Ando T, Lemor A, Jain T, Michel P, Basir M, and Alaswad K. Transradial versus transfemoral approach for percutaneous coronary intervention of chronic total occlusions: A meta-analysis and meta-regression. Catheter Cardiovasc Interv 2019; 93(Suppl 2):S65-S66.
Catheter Cardiovasc Interv
Background: Efficacy and safety of transradial approach (TRA) versus transfemoral approach (TFA) in chronic total occlusion percutaneous coronary intervention (CTO PCI) have not yet been determined. We performed a meta-analysis to compare TRA and TFA in CTO PCI. Methods: We comprehensively searched EMBASE, PubMed, and Web of Science. The primary endpoint was procedural success. Secondary endpoints were access site-related complications and bleeding, all-cause mortality, myocardial infarction (MI), contrastinduced nephropathy (CIN), contrast volume, fluoroscopy time, procedure time, urgent surgery, and coronary artery complications. Difference in Means (DM), Odds Ratios (OR) and 95% Confidence Intervals (CI) were computed with the Mantel-Haenszel method. Random effects model was used with heterogeneity considered if I2 > 25. Results: Eight observational studies (n = 10,420 patients) were included in the analysis. There was no significant difference in procedural success between TRA versus TFA cohorts (OR 1.02; 95% CI, 0.77-1.36). CTO-PCI performed via TRA had lower access site-related complications and bleeding (OR 0.41; 95% CI, 0.24-0.71) and MI (OR 0.45; 95% CI 0.21-0.94) compared to CTO-PCI performed via TFA. There were no significant differences in all-cause mortality (OR, 0.84; 95% CI, 0.60-1.02), urgent surgery (OR, 0.79; 95% CI, 0.29-2.11), coronary artery complications (OR, 0.72; 95% CI, 0.33-1.57), CIN (OR, 0.31; 95% CI, 0.06-1.73), contrast volume (DM, -18.35; 95% CI, -42.99 to 6.29), procedure time (DM, 1.29; 95% CI, -14.84 to 7.42), and fluoroscopy time (DM, -2.50; 95% CI, -7.77 to 2.77) between the two groups. No association was observed in the meta-regression analysis. Conclusions: CTO-PCI via TRA was associated with lower access site-related complications, bleeding, and MI while achieving similar procedural success and similar procedural and fluoroscopy times when compared to TFA.