Title

Transradial versus transfemoral approach for percutaneous coronary intervention of chronic total occlusions: A meta-analysis and meta-regression

Document Type

Conference Proceeding

Publication Date

2019

Publication Title

Catheter Cardiovasc Interv

Abstract

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.

Volume

93

Issue

Suppl 2

First Page

S65

Last Page

S66

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