Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta-analysis of observational studies
Corresponding Author
Tomo Ando MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Correspondence
Tomo Ando, Detroit Medical Center, Division of Cardiology, 3990, John R, Detroit, MI 48201.
Email: [email protected]
Search for more papers by this authorShunsuke Aoi MD
Department of Medicine Division of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York
Search for more papers by this authorSaid Ashraf MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorPedro A. Villablanca MD, MSc
Department of Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
Search for more papers by this authorAlexandros Briasoulis MD, PhD
Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, Iowa
Search for more papers by this authorHisato Takagi MD, PhD
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Department of Medicine, Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Search for more papers by this authorLuis Afonso MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorCindy L. Grines MD
Department of Medicine Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, New York
Search for more papers by this authorCorresponding Author
Tomo Ando MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Correspondence
Tomo Ando, Detroit Medical Center, Division of Cardiology, 3990, John R, Detroit, MI 48201.
Email: [email protected]
Search for more papers by this authorShunsuke Aoi MD
Department of Medicine Division of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York
Search for more papers by this authorSaid Ashraf MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorPedro A. Villablanca MD, MSc
Department of Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
Search for more papers by this authorAlexandros Briasoulis MD, PhD
Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, Iowa
Search for more papers by this authorHisato Takagi MD, PhD
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Department of Medicine, Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Search for more papers by this authorLuis Afonso MD
Department of Medicine Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorCindy L. Grines MD
Department of Medicine Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, New York
Search for more papers by this authorAbstract
Objectives
To assess the efficacy and safety of transradial (TR) versus transfemoral (TF) percutaneous coronary intervention (PCI) in left main (LM) lesion.
Background
TR-PCI is the preferred approach compared with TF approach because of less bleeding risk. LM-PCI is often challenging because of the anatomical complexity and uniqueness of supplying a large myocardium territory. We performed a systematic review and meta-analysis to assess the safety and efficacy of TR-PCI compared with TF-PCI of the LM lesions.
Methods
A comprehensive literature search of PUBMED, EMBASE, and Cochrane database was conducted to identify studies that reported the comparable outcomes between both approaches. Odds ratio (OR) and 95% confidence interval (CI) was calculated using the Mantel–Haenszel method.
Results
A total of eight studies were included in the quantitative meta-analysis. TR-PCI resulted in lower bleeding risk (OR 0.31, 95%CI 0.18–0.52, P < 0.01, I2 = 0%) while maintaining similar procedural success rate, target lesion revascularization, myocardial infarction, stent thrombosis, and all-cause mortality during the study follow-up period.
Conclusions
TR-PCI may achieve similar efficacy with decreased bleeding risk compared to TF-PCI in LM lesions. When operator experience and anatomical complexity are favorable, TR approach is an attractive alternative access over TF approach in LM-PCI.
CONFLICT OF INTEREST
All authors have no conflict of interests and this study was not funded by any organization or source.
Supporting Information
| Filename | Description |
|---|---|
| ccd28025_sup-0001-Supplement1.docxWord 2007 document , 61 KB | Supplement 1: Definitions of clinical outcomes used in the meta-analysis from each study. |
| ccd28025_sup-0002-Supplement2.tiffTIFF image, 25.8 MB | Supplement 2: Sensitivity analysis result for procedural success rate by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0003-Supplement3.tiffTIFF image, 25.8 MB | Supplement 3: Sensitivity analysis result bleeding by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0004-Supplement4.tiffTIFF image, 25.8 MB | Supplement 4: Sensitivity analysis result of target-lesion revascularization by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0005-Supplement5.tiffTIFF image, 25.8 MB | Supplement 5: Sensitivity analysis result of myocardial infarction by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0006-Supplement6.tiffTIFF image, 25.8 MB | Supplement 6: Sensitivity analysis result of stent thrombosis by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0007-Supplement7.tiffTIFF image, 25.8 MB | Supplement 7: Sensitivity analysis result of all-cause mortality by sequentially removing each study at a time to re-calculate the effect size. |
| ccd28025_sup-0008-Supplement8.docxWord 2007 document , 74.6 KB | Supplement 8: Newcastle-Ottawa scale for the included cohort studies |
| ccd28025_sup-0009-Supplement9.tiffTIFF image, 25.8 MB | Supplement 9: Cumulative analysis of bleeding events |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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