Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials
Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials
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DOI：
10.1016/j.ahj.2008.08.023
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发表时间：
2009-01-01
影响因子：
4.8
通讯作者：
Mehta, Shamir R.
中科院分区：
文献类型：
--
作者：
Jolly, Sanjit S.;Amlani, Shoaib;Mehta, Shamir R.
背景：小型随机试验表明，与股骨入路相比，桡骨入路可减少入路部位并发症。本荟萃分析的目的是确定与股骨入路相比，桡动脉入路是否能减少大出血，从而减少死亡和缺血事件。方法检索自1980年至2008年4月的MEDLINE、EMBASE和CENTRAL数据库。检索2005年至2008年4月的相关会议摘要。包括比较桡动脉与股动脉冠状动脉造影或介入治疗报告大出血、死亡、心肌梗死和手术或透视时间的随机试验。采用固定效应模型和随机效应进行敏感性分析。结果桡骨入路与股骨入路相比减少了73%的大出血（0.05% vs 2.3%, OR 0.27 [95% CI 0.16, 0.45], P < .001）。死亡、心肌梗死或中风的综合发生率有降低的趋势（2.5%比3.8%,or 0.71 [95% CI 0.49-1.01], P = 0.058）以及死亡率（1.2%比1.8% or 0.74 [95% CI 0.42-1.30], P = 0.29）。经皮冠状动脉介入治疗桡动脉通路时，不能使用金属丝、球囊或支架的比例更高（4.7%a vs 3.4% or 1.29 [95% CI 0.87, 1.94], P = 0.21）。放射状通路使住院时间缩短了0.4天（95% CI 0.2-0.5, P = 0.0001）。结论与股动脉入路相比，桡动脉入路可减少大出血，并有相应的减少缺血事件的趋势。需要大型随机试验来证实径向通路对死亡和缺血性事件的益处。（美国心脏杂志2009；157:132-40。）
Background Small randomized trials have demonstrated that radial access reduces access site complications compared to a femoral approach. The objective of this meta-analysis was to determine if radial access reduces major bleeding and as a result can reduce death and ischemic events compared to femoral access.Methods MEDLINE, EMBASE, and CENTRAL were searched from 1980 to April 2008. Relevant conference abstracts from 2005 to April 2008 were searched. Randomized trials comparing radial versus femoral access coronary angiography or intervention that reported major bleeding, death, myocardial infarction, and procedural or fluoroscopy time were included. A fixed-effects model was used with a random effects for sensitivity analysis.Results Radial access reduced major bleeding by 73% compared to femoral access (0.05% vs 2.3%, OR 0.27 [95% CI 0.16, 0.45], P < .001). There was a trend for reductions in the composite of death, myocardial infarction, or stroke (2.5% vs 3.8%, OR 0.71 [95%a CI 0.49-1.01], P = .058) as well as death (1.2% vs 1.8% OR 0.74 [95% CI 0.42-1.30], P = .29). There was a trend for higher rate of inability to the cross lesion with wire, balloon, or stent during percutaneous coronary intervention with radial access (4.7%a vs 3.4% OR 1.29 [95% CI 0.87, 1.94], P = .21). Radial access reduced hospital stay by 0.4 days (95% CI 0.2-0.5, P = .0001).Conclusions Radial access reduced major bleeding and there was a corresponding trend for reduction in ischemic events compared to femoral access. Large randomized trials are needed to confirm the benefit of radial access on death and ischemic events. (Am Heart J 2009;157:132-40.)