PLoS ONE (Jan 2022)

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.

  • Nagendra Boopathy Senguttuvan,
  • Pothireddy M K Reddy,
  • PunatiHari Shankar,
  • Rizwan Suliankatchi Abdulkader,
  • Hanumath Prasad Yallanki,
  • Ashish Kumar,
  • Monil Majmundar,
  • Vadivelu Ramalingam,
  • Ravindran Rajendran,
  • Kesavamoorthy Bhoopalan,
  • Dhamodharan Kaliyamoorthy,
  • Muralidharan T R,
  • Ankur Kalra,
  • Ramamoorthi Jayaraj,
  • Sivasubramanian Ramakrishnan,
  • Ramesh Daggubati,
  • Sadagopan Thanikachalam,
  • Ashok Seth,
  • Vinay Kumar Bahl

DOI
https://doi.org/10.1371/journal.pone.0266709
Journal volume & issue
Vol. 17, no. 4
p. e0266709

Abstract

Read online

IntroductionTrans-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 resultsWe 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.ConclusionTRA 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.