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Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: Systematic review, collaborative meta-analysis, and meta-regression.
- Source :
-
International journal of cardiology [Int J Cardiol] 2016 Nov 01; Vol. 222, pp. 1031-1039. Date of Electronic Publication: 2016 Jul 30. - Publication Year :
- 2016
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Abstract
- Background: Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients.<br />Methods: We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients. Included studies had to meet the following criteria: 1) enrolling patients with NSTE-ACS undergoing invasive management; 2) reporting outcomes with respect to RA as compared with femoral access (FA); 3) reporting short-term (procedural, in-hospital and up to 30-day) or long-term clinical outcomes. Studies were pooled with fixed and random effects models and heterogeneity was investigated by weighted meta-regression.<br />Results: Eleven studies were included encompassing 131.339 patients, 46.451 receiving RA and 84.888 receiving FA. Thirty-day mortality and MACE were lower with RA (p<0.001 with fixed effects, p=NS with random effects model), but these results depended on one large observational database. Major bleeding was consistently reduced by RA (p<0.001), albeit an inverse relationship with the proportion of patients in each study receiving FA and experiencing major bleeding was evident. The association of RA with reduced long-term mortality was of borderline significance (p=0.054 with random-effects, p=0.001 with fixed-effect model) and also depended on major bleeding in FA patients.<br />Conclusions: RA is associated with better outcomes as compared with FA in NSTE-ACS, although this observation is influenced by nonrandomized comparisons. Large heterogeneity exists among studies.<br />Registration: This study is registered in the PROSPERO database (CRD42015029459).<br /> (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Acute Coronary Syndrome diagnostic imaging
Acute Coronary Syndrome epidemiology
Coronary Angiography methods
Humans
Observational Studies as Topic methods
Radial Artery diagnostic imaging
Randomized Controlled Trials as Topic methods
ST Elevation Myocardial Infarction diagnostic imaging
ST Elevation Myocardial Infarction epidemiology
Acute Coronary Syndrome surgery
Percutaneous Coronary Intervention methods
Radial Artery surgery
ST Elevation Myocardial Infarction surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 222
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27537543
- Full Text :
- https://doi.org/10.1016/j.ijcard.2016.07.228