Meta-analysis of Transradial versus Transfemoral Access for Percutaneous Coronary Intervention in Patients with Advanced Kidney Disease
Presenter
Azka Latif, MD, CHI Health Creighton University Medical Center, omaha, NE
Azka Latif, MD1, Muhammad Junaid Ahsan2, Sarah Aurit2, Mohsin Mirza3, Jolanta Maria Siller-Matula, MD, PhD4, Manish Parikh5, J. Dawn Abbott, M.D., FSCAI6, Mamas A. Mamas, M.D., FRCP, FSCAI7, Emmanouil S. Brilakis, MD, PhD, FSCAI8, Deepak L. Bhatt, M.D., M.P.H., MSCAI9 and Poonam Velagapudi, MD MS, FSCAI10, (1)CHI Health Creighton University Medical Center, omaha, NE, (2)CHI Health Creighton University Medical Center, Omaha, NE, (3)CHI health Creighton University Medical Canter, omaha, NE, Pakistan, (4)Medical University of Vienna, Vienna, Austria, (5)Weill Cornell Medicine, New York, NY, (6)Rhode Island Hospital, Barrington, RI, (7)Keele University, Stoke-on-Trent, Staffordshire, United Kingdom, (8)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (9)Mount Sinai Health System, Scarsdale, NY, (10)The University of Nebraska Medical Center, Demarest, NJ
Keywords: Acute Coronary Syndromes (ACS), Complications and Coronary
Background
Data comparing outcomes of transradial (TR) versus transfemoral (TF) approaches for percutaneous coronary intervention (PCI) in advanced kidney disease (AKD) including chronic kidney disease with eGFR< 30ml/min/1.73m
2 or end stage renal disease on dialysis are lacking. This meta-analysis compares the outcomes of PCI via a TR versus TF approach for PCI in patients with AKD.
Methods
PubMed, Embase, Cochrane, ClinicalTrials.gov, and Google Scholar were searched for studies including adults with AKD undergoing PCI via a TR versus TF approach from January 1, 2000 until December 30, 2020. The primary outcome was in-hospital all-cause mortality and secondary outcomes included bleeding, stroke, myocardial infarction (MI), and transfusion. Analysis was conducted per PRISMA guidelines using STATA version 15.1 software.
Results
Five studies, (all observational) were included in the analysis with 1,156 and 6,156 patients in the TR and TF arms, respectively. Mean age of patients was 71.2 years with 44% being female and 56% being male. In patients with AKD, TR access for PCI was associated with lower all-cause mortality (RR=0.48; 95% CI: 0.32 to 0.73), and bleeding (RR=0.51; 95% CI: 0.36 to 0.73) with no difference in stroke, MI, or transfusion (Figure 1) compared with TF access.
Conclusions
In patients with AKD, PCI via a TR approach was associated with a lower risk of post-procedural bleeding and in-hospital mortality compared with TF access. There was no difference between the access sites in stroke, MI, or receipt of blood transfusion.
