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Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis.
- Source :
-
European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2022 Sep 05; Vol. 8 (6), pp. 640-650. - Publication Year :
- 2022
-
Abstract
- Background: In ST-elevation myocardial infarction (STEMI), transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with less bleeding and mortality than transfemoral access (TFA). However, patients in cardiogenic shock (CS) are more often treated via TFA. The aim of this meta-analysis is to compare the safety and efficacy of TRA vs. TFA in CS.<br />Methods: Systematic review was performed querying PubMed, Google Scholar, Cochrane, and clinicaltrials.gov for studies comparing TRA to TFA in PCI for CS. Outcomes included in-hospital, 30-day and ≥1-year mortality, major and access site bleeding, TIMI3 (thrombolytics in myocardial infarction) flow, procedural success, fluoroscopy time, and contrast volume. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models.<br />Results: Six prospective and eight retrospective studies (TRA, n = 8032; TFA, n = 23 031) were identified. TRA was associated with lower in-hospital (RR 0.59, 95% CI 0.52-0.66, P &lt; 0.0001), 30-day and ≥1-year mortality, as well as less in-hospital major (RR 0.41, 0.31-0.56, P &lt; 0.001) and access site bleeding (RR 0.42, 0.23-0.77, P = 0.005). There were no statistically significant differences in post-PCI coronary flow grade, procedural success, fluoroscopy time, and contrast volume between TRA vs. TFA.<br />Conclusions: In PCI for STEMI with CS, TRA is associated with significantly lower mortality and bleeding complications than TFA while achieving similar TIMI3 flow and procedural success rates.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Subjects :
- Femoral Artery
Hemorrhage
Humans
Prospective Studies
Radial Artery
Retrospective Studies
Risk Factors
Shock, Cardiogenic etiology
Treatment Outcome
Catheterization, Peripheral adverse effects
Percutaneous Coronary Intervention adverse effects
ST Elevation Myocardial Infarction complications
ST Elevation Myocardial Infarction surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2058-1742
- Volume :
- 8
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European heart journal. Quality of care & clinical outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 35460230
- Full Text :
- https://doi.org/10.1093/ehjqcco/qcac018