Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials
Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies w...
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| description | Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed.
Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p |
| doi_str_mv | 10.1371/journal.pone.0096127 |
| format | Article |
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Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p<0.001); these findings were supported by trial sequential analyses.
In patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. However, because of the clinical relevance associated with major bleeding and vascular complications reduction, TRA should be recommended as first-choice vascular access in patients with ACS undergoing cardiac catheterization.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0096127</identifier><identifier>PMID: 24820096</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Access control ; Acute Coronary Syndrome - surgery ; Acute coronary syndromes ; Analysis ; Angioplasty ; Balloon angioplasty ; Bias ; Bleeding ; Cardiac patients ; Cardiology ; Catheterization ; Clinical trials ; Complications ; Confidence intervals ; Coronary heart disease ; Death ; Electrocardiography ; Female ; Femoral Artery - surgery ; Health aspects ; Heart attacks ; Heart diseases ; Humans ; Intervention ; Intubation ; Male ; Medicine and Health Sciences ; Meta-analysis ; Mortality ; Patients ; Percutaneous Coronary Intervention - methods ; Radial Artery - surgery ; Randomization ; Randomized Controlled Trials as Topic ; Regression analysis ; Risk ; Sequential analysis ; Statistical analysis ; Studies ; Treatment Outcome ; Websites</subject><ispartof>PloS one, 2014-05, Vol.9 (5), p.e96127-e96127</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Piccolo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Piccolo et al 2014 Piccolo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-457325f7e8e4d1ada59a4ce2cb7845b0827c9b8c4addb19e011a134611db2e233</citedby><cites>FETCH-LOGICAL-c692t-457325f7e8e4d1ada59a4ce2cb7845b0827c9b8c4addb19e011a134611db2e233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018335/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018335/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24820096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Cortese, Bernardo</contributor><creatorcontrib>Piccolo, Raffaele</creatorcontrib><creatorcontrib>Galasso, Gennaro</creatorcontrib><creatorcontrib>Capuano, Ernesto</creatorcontrib><creatorcontrib>De Luca, Stefania</creatorcontrib><creatorcontrib>Esposito, Giovanni</creatorcontrib><creatorcontrib>Trimarco, Bruno</creatorcontrib><creatorcontrib>Piscione, Federico</creatorcontrib><title>Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed.
Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p<0.001); these findings were supported by trial sequential analyses.
In patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. 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A meta-analysis and trial sequential analysis of randomized controlled trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-05-12</date><risdate>2014</risdate><volume>9</volume><issue>5</issue><spage>e96127</spage><epage>e96127</epage><pages>e96127-e96127</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Transfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed.
Medline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53-0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41-0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28-0.46; p<0.001); these findings were supported by trial sequential analyses.
In patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. However, because of the clinical relevance associated with major bleeding and vascular complications reduction, TRA should be recommended as first-choice vascular access in patients with ACS undergoing cardiac catheterization.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24820096</pmid><doi>10.1371/journal.pone.0096127</doi><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Access control Acute Coronary Syndrome - surgery Acute coronary syndromes Analysis Angioplasty Balloon angioplasty Bias Bleeding Cardiac patients Cardiology Catheterization Clinical trials Complications Confidence intervals Coronary heart disease Death Electrocardiography Female Femoral Artery - surgery Health aspects Heart attacks Heart diseases Humans Intervention Intubation Male Medicine and Health Sciences Meta-analysis Mortality Patients Percutaneous Coronary Intervention - methods Radial Artery - surgery Randomization Randomized Controlled Trials as Topic Regression analysis Risk Sequential analysis Statistical analysis Studies Treatment Outcome Websites |
| title | Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T20%3A11%3A08IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Transradial%20versus%20transfemoral%20approach%20in%20patients%20undergoing%20percutaneous%20coronary%20intervention%20for%20acute%20coronary%20syndrome.%20A%20meta-analysis%20and%20trial%20sequential%20analysis%20of%20randomized%20controlled%20trials&rft.jtitle=PloS%20one&rft.au=Piccolo,%20Raffaele&rft.date=2014-05-12&rft.volume=9&rft.issue=5&rft.spage=e96127&rft.epage=e96127&rft.pages=e96127-e96127&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0096127&rft_dat=%3Cgale_plos_%3EA418552882%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1523871123&rft_id=info:pmid/24820096&rft_galeid=A418552882&rft_doaj_id=oai_doaj_org_article_d9a8831216454c049b8875faf2d0c8f8&rfr_iscdi=true |