Meta-analysis of randomized trials on access site selection for percutaneous coronary intervention in ST-segment elevation myocardial infarction

András Komócsi, Dániel Aradi, Dániel Kehl, Imre Ungi, Attila Thury, Tünde Pintér, James J. Di Nicolantonio, Adrienn Tornyos, András Vorobcsuk

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Introduction: Superior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI. Material and methods: Electronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model. Results: Twelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38-0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43-0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52-0.86), p = 0.002 respectively). Conclusions: Robust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.

Original languageEnglish
Pages (from-to)203-212
Number of pages10
JournalArchives of Medical Science
Volume10
Issue number2
DOIs
Publication statusPublished - Apr 2014

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Keywords

  • Death
  • ST-segment elevation myocardial infarction
  • Transfemoral
  • Transradial

ASJC Scopus subject areas

  • Medicine(all)

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