Meta-Analysis of Transradial vs Transfemoral Access for Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction

Jhand, Aravdeep; Atti, Varunsiri; Gwon, Yeongjin; Dhawan, Rahul; Turagam, Mohit K.; Mamas, Mamas A.; Brilakis, Emmanouil S.; Kumar, Arnav; Katta, Natraj; Chatzizisis, Yiannis S.; Parikh, Manish; Abbott, J. Dawn; Kirtane, Ajay J.; Bhatt, Deepak L.; Velagapudi, Poonam

doi:10.1016/j.amjcard.2020.11.016

Cited by 21 publications

(11 citation statements)

References 22 publications

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“…This is especially important in patients with STEMI where more potent anti-thrombotic would be used. Similar to our metanalysis, Jhand et al [ 28 ] have shown that TRA procedures are associated with lower all-cause mortality and bleeding in patients with STEMI. In systems of care where pharmaco-invasive and rescue PCI therapy is utilized for STEMI, TRA acts as a boon to prevent access site-related bleeding complications.…”

Section: Discussionsupporting

confidence: 89%

Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

et al. 2022

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Introduction Trans-radial approach (TRA) is recommended over trans-femoral approach (TFA) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We intended to study the effect of access on all-cause mortality. Methods and results We searched PubMed and EMBASE for randomized studies on patients with ACS undergoing PCI. The primary outcome was all-cause mortality at 30-days. The secondary outcomes included in-hospital mortality, major adverse cardiac or cerebrovascular event (MACE) as defined by the study, net adverse clinical event (NACE), non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, study-defined major bleeding, and minor bleeding, vascular complications, hematoma, pseudoaneurysm, non-access site bleeding, need for transfusion, access site cross-over, contrast volume, procedure duration, and hospital stay duration. We studied 20,122 ACS patients, including 10,037 and 10,085 patients undergoing trans-radial and trans-femoral approaches, respectively. We found mortality benefit in patients with ACS for the trans-radial approach [(1.7% vs. 2.3%; RR: 0.75; 95% CI: 0.62–0.91; P = 0.004; I2 = 0%). Out of 10,465 patients with STEMI, 5,189 patients had TRA and 5,276 had TFA procedures. A similar benefit was observed in patients with STEMI alone [(2.3% vs. 3.3%; RR: 0.71; 95% CI: 0.56–0.90; P = 0.004; I2 = 0%). We observed reduced MACE, NACE, major bleeding, vascular complications, and pseudoaneurysms. No difference in re-infarction, stroke, and serious bleeding requiring blood transfusions were noted. We noticed a small decrease in contrast volume(ml) {mean difference (95% CI): −4.6 [−8.5 to −0.7]}, small but significantly increase in procedural time {mean difference (95% CI) 1.2 [0.1 to 2.3]}and fluoroscopy time {mean difference (95% CI) 0.8 [0.3 to1.4] min} in the trans-radial group. Conclusion TRA has significantly reduced 30-day all-cause mortality among patients undergoing PCI for ACS. TRA should be the preferred vascular access in patients with ACS.

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Section: Discussionsupporting

confidence: 89%

Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

et al. 2022

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“…Another significant factor is vascular access. Transradial access was found to be associated with a lower risk of allcause mortality, major bleeding, and vascular complications compared with transfemoral access in PCI patients with ST-segment elevation myocardial infarction [23]. However, an opposite correlation was suggested in the group of RA patients, where transradial access was found to be significantly related to greater coronary artery perforation rate, with no significance for periprocedural mortality, overall complication count, or other periprocedural complications [18].…”

Section: Discussionmentioning

confidence: 98%

Sex-related differences and rotational atherectomy: Analysis of 5 177 percutaneous coronary interventions based on a large national registry from 2014 to 2020

Sabatowski¹,

Malinowski

Siudak

et al. 2021

Kardiol Pol

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Background: Patients undergoing percutaneous coronary interventions (PCI) with rotational atherectomy (RA) have massively calcified coronary arteries and their prognosis differs between sexes. Aims:The aim of the study was to evaluate the trends in the percentage of sexes in the subsequent years, to compare demographic characteristics between men and women, and to identify factors associated with the risk of periprocedural complications and death. Methods:We analyzed data on 751 113 patients treated with PCI between 2014 and 2020 from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI). We extracted data on 5 177 (0.7%) patients treated with RA of whom 3 552 (68.6%) were men. To determine risk factors of periprocedural complications and death, a multivariable analysis was performed. Results:The proportion of PCIs involving RA increased between 2014 and 2020 (P <0.001). Almost twice as many RA procedures were performed on men (68.55%), and that proportion did not change in the following years. The female patients were older (75.2 [8.3] vs. 70.5 [9.2] years; P <0.001). When considering periprocedural complications, their overall rate (3.45% vs. 2.31%; P = 0.01) and death rate (0.68% vs. 0.17%; P = 0.006) were greater among women. Also, via multivariable analysis, female sex was found to be a risk factor for greater periprocedural mortality (P = 0.02) and overall complication rate (P = 0.007). 1321 Karol Sabatowski et al., Rotational atherectomy and sex w w w . j o u r n a l s . v i a m e d i c a . p l / k a r d i o l o g i a _ p o l s k a W H a t ' S n e W ?Female sex is associated with poorer clinical outcomes after percutaneous coronary interventions (Pcis) including a higher risk of death, myocardial infarction or target vessel failure, and lesion failure in long-term follow-up. Patients undergoing Pci with rotational atherectomy (ra) have massively calcified coronary arteries and differ according to sex. We aimed to assess the trends in the percentage of sexes in the years 2014-2020, to compare demographic characteristics between men and women and to identify factors associated with the risk of periprocedural complications and death. Out of 751 113 patients treated with Pci between 2014 and 2020, we extracted data on 5 177 (0.7%) patients treated with ra of whom 3 552 (68.6%) were men. Sex-related distribution of patients treated with ra was stable during the analyzed period. Multivariable regression analysis confirmed that female sex is a risk factor of periprocedural complications and mortality in patients treated with Pci and ra.

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“…A large body of evidence exists in STEMI patients in supporting the role of CCR in patients with MVD undergoing primary PCI [27][28][29][30][31][32] and recently the benefit of CCR in NSTEMI patients with MVD has been suggested [6,32]. However, the long-term prognosis benefit of CCR is not well known in elderly people.…”

Section: Discussionmentioning

confidence: 99%

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Agra-Bermejo¹,

Cordero²,

Veloso³

et al. 2021

Rev. Cardiovasc. Med.

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The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median followup was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57-0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47-0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.

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Meta-Analysis of Transradial vs Transfemoral Access for Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction

Cited by 21 publications

References 22 publications

Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

Sex-related differences and rotational atherectomy: Analysis of 5 177 percutaneous coronary interventions based on a large national registry from 2014 to 2020

Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

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