Transradial versus Transfemoral Approach for Percutaneous Coronary Intervention of Chronic Total Occlusions: A Meta-Analysis and Meta-Regression

Alrayes, Hussayn

Transradial versus Transfemoral Approach for Percutaneous Coronary Intervention of Chronic Total Occlusions: A Meta-Analysis and Meta-Regression

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Hussayn Alrayes, D.O. , Henry Ford Health System, Detroit, MI

Pedro Villablanca, M.D. , Henry Ford Health System, Detroit, MI

Georgi Fram, M.D. , Henry Ford Hospital, Detroit, MI

Tomo Ando, M.D. , Wayne State University/Detroit Medical Center Program/Harper University, Detroit, MI

Alejandro Lemor, M.D. , Henry Ford Health System, Detroit, MI

Tarun Jain, M.B.B.S. , Henry Ford Health System, Detroit, MI

Pablo Michel, M.D. , University of Texas Health Science Center-San Antonio, San Antonio, TX

Mir B. Basir, D.O., FSCAI , Henry Ford Health System, Detroit, MI

Khaldoon Alaswad, M.D. , Henry Ford Health System, Detroit, MI

Background
Efficacy and safety of transradial approach (TRA) versus transfemoral approach (TFA) in chronic total occlusion percutaneous coronary intervention (CTO PCI) have not yet been determined. We performed a meta-analysis to compare TRA and TFA in CTO PCI.

Methods
We comprehensively searched EMBASE, PubMed, and Web of Science. The primary endpoint was procedural success. Secondary endpoints were access site–related complications and bleeding, all-cause mortality, myocardial infarction (MI), contrast-induced nephropathy (CIN), contrast volume, fluoroscopy time, procedure time, urgent surgery, and coronary artery complications. Difference in Means (DM), Odds Ratios (OR) and 95% Confidence Intervals (CI) were computed with the Mantel-Haenszel method. Random effects model was used with heterogeneity considered if I² >25.

Results
Eight observational studies (n=10,420 patients) were included in the analysis. There was no significant difference in procedural success between TRA versus TFA cohorts (OR 1.02; 95% CI, 0.77-1.36). CTO-PCI performed via TRA had lower access site-related complications and bleeding (OR 0.41; 95% CI, 0.24-0.71) and MI (OR 0.45; 95% CI 0.21-0.94) compared to CTO-PCI performed via TFA. There were no significant differences in all-cause mortality (OR, 0.84; 95% CI, 0.60-1.02), urgent surgery (OR, 0.79; 95% CI, 0.29-2.11), coronary artery complications (OR, 0.72; 95% CI, 0.33-1.57), CIN (OR, 0.31; 95% CI, 0.06-1.73), contrast volume (DM, -18.35; 95% CI, -42.99 to 6.29), procedure time (DM, 1.29; 95% CI, -14.84 to 7.42), and fluoroscopy time (DM, -2.50; 95% CI, -7.77 to 2.77) between the two groups. No association was observed in the meta-regression analysis.

Conclusions
CTO-PCI via TRA was associated with lower access site–related complications, bleeding, and MI while achieving similar procedural success and similar procedural and fluoroscopy times when compared to TFA.