Article ; Online: Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention.
The American journal of cardiology
2023 Volume 192, Page(s) 245–254
Abstract: The aim of this study was to compare the efficacy and safety of transradial approach (TRA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the efficacy and safety of transfemoral approach (TFA). We conducted a systematic ... ...
| Abstract | The aim of this study was to compare the efficacy and safety of transradial approach (TRA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the efficacy and safety of transfemoral approach (TFA). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) reporting the outcomes of TRA versus TFA in CTO PCI. The primary end point was procedural success. Secondary end points included access-site complications, in-hospital adverse events, procedural efficacy outcomes, and 30-day all-cause mortality. A total of 28,754 CTO PCI cases from 19 studies were included (2 RCTs and 17 OS). The pooled mean J-CTO score is 2.3. The main analysis showed a trend toward a higher success rate for TRA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.00 to 1.38), but this was not the case in the secondary analysis, which included only RCTs and OS with moderate risk of bias (OR 0.99, 95% CI 0.81 to 1.22). TRA was associated with significant reductions in access-site complications (OR 0.33, 95% CI 0.24 to 0.45) and major bleeding (OR 0.34, 95% CI 0.20 to 0.59), and a similar risk of other in-hospital adverse events and 30-day mortality (p >0.05) to that of TFA. Moreover, there was less fluoroscopy time (minutes) and contrast volume use (ml) in the transradial CTO PCI (mean difference: -6.19 [-10.98 to -1.40] and -22.14[-34.56 to -9.72], respectively). In conclusion, the transradial PCI in appropriate CTO lesions was associated with a lower incidence of access-site complications/major bleeding than was TFA and a similar other periprocedural complications rate, without compromising procedural success. |
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| MeSH term(s) | Humans ; Coronary Occlusion/etiology ; Femoral Artery ; Hemorrhage/etiology ; Observational Studies as Topic ; Percutaneous Coronary Intervention/adverse effects ; Radial Artery ; Randomized Controlled Trials as Topic ; Risk Factors ; Treatment Outcome | |||||
| Language | English | |||||
| Publishing date | 2023-01-27 | |||||
| Publishing country | United States | |||||
| Document type | Systematic Review ; Meta-Analysis ; Journal Article | |||||
| ZDB-ID | 80014-4 | |||||
| ISSN | 1879-1913 ; 0002-9149 | |||||
| ISSN (online) | 1879-1913 | |||||
| ISSN | 0002-9149 | |||||
| DOI | 10.1016/j.amjcard.2023.01.005 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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