scholarly journals Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (10) ◽  
pp. 2163
Author(s):  
Gani Bajraktari ◽  
Zarife Rexhaj ◽  
Shpend Elezi ◽  
Fjolla Zhubi-Bakija ◽  
Artan Bajraktari ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Clinical Outcome ◽  
Major Bleeding ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

scholarly journals 494 Glycoprotein IIB/IIIA inhibitors may modulate the clinical benefit of radial access as compared to femoral access in primary percutaneous coronary intervention: a meta-regression and a meta-analysis of randomized trials

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Ernesto Cristiano ◽  
Francesco Cava ◽  
Maria Lo Monaco ◽  
Federica Tempestini ◽  
Francesca Giovannelli ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Risk Difference ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Meta Regression

Abstract Aims Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favour of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access. Methods and results We computed pooled estimates by the random effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. We analysed 14 randomized controlled trials and 11 090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality [risk difference 0.01 (0.00, 0.01), P = 0.03], MACE [risk difference 0.01 (0.00, 0.02), P = 0.003], and major bleedings [risk difference 0.01 (0.00, 0.02), P = 0.02]. At meta-regression, we observed a significant correlation of mortality with both GPI use (P = 0.011) and year of publication (P = 0.0073), whereas no correlation was observed with major bleedings. Conclusions In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.

scholarly journals Glycoprotein IIb/IIIa Inhibitors May Modulate the Clinical Benefit of Radial Access as Compared to Femoral Access in Primary Percutaneous Coronary Intervention: A Meta-Regression and Meta-Analysis of Randomized Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Stefano Rigattieri ◽  
Ernesto Cristiano ◽  
Francesca Giovannelli ◽  
Antonella Tommasino ◽  
Francesco Cava ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Risk Difference ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Meta Regression

Objectives. Several randomized controlled trials (RCTs) consistently reported better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI). Nevertheless, heterogeneous use of potent antiplatelet drugs, such as Gp IIb/IIIa inhibitors (GPI), across different studies could have biased the results in favor of radial access. We performed an updated meta-analysis and meta-regression of RCTs in order to appraise whether the use of GPI had an impact on pooled estimates of clinical outcomes according to vascular access. Methods. We computed pooled estimates by the random-effects model for the following outcomes: mortality, major adverse cardiovascular events (death, myocardial infarction, stroke, and target vessel revascularization), and major bleedings. Additionally, we performed meta-regression analysis to investigate the impact of GPI use on pooled estimates of clinical outcomes. Results. We analyzed 14 randomized controlled trials and 11090 patients who were treated by radial (5497) and femoral access (5593), respectively. Radial access was associated with better outcomes for mortality (risk difference 0.01 (0.00, 0.01), p = 0.03 ), MACE (risk difference 0.01 (0.00, 0.02), p = 0.003 ), and major bleedings (risk difference 0.01 (0.00, 0.02), p = 0.02 ). At meta-regression, we observed a significant correlation of mortality with both GPI use ( p = 0.011 ) and year of publication ( p = 0.0073 ), whereas no correlation was observed with major bleedings. Conclusions. In this meta-analysis, the use of radial access for primary PCI was associated with better clinical outcomes as compared to femoral access. However, the effect size on mortality was modulated by GPI rate, with greater benefit of radial access in studies with larger use of these drugs.

scholarly journals Radial versus femoral access for coronary angiography and interventions: a systematic review and meta-analysis of randomized trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Chiarito ◽  
D Cao ◽  
J Nicolas ◽  
A Roumeliotis ◽  
D Power ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Significant Risk ◽  
Number Needed To Treat ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
All Cause Mortality

Abstract Background The presence of any benefits associated with radial or femoral access among patients undergoing coronary angiography and percutaneous coronary interventions (PCI) is still debated. Purpose Our aim is to provide a comprehensive quantitative appraisal of the effects of access site on the risks of stroke, myocardial infarction, and major bleeding in patients undergoing coronary angiography with or without PCI. Methods In January 2020, we searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access for coronary angiography with or without subsequent PCI. Odds ratios (OR) were used as metric of choice for treatment effects with random-effects models. Co-primary efficacy endpoints were stroke and myocardial infarction. Primary safety endpoint was major bleeding. Secondary endpoints were all cause mortality and vascular complications. Heterogeneity was assessed with the I-squared index. This study is registered with PROSPERO. Results We identified 31 trials, including 30,414 patients. Risks of stroke (OR 1.11, 95% CI 0.76–1.64, I2=0%) and myocardial infarction (OR 0.90, 95% CI 0.79–1.03, I2=0%) were comparable between radial and femoral access. Radial access was associated with a reduction for the risk of major bleeding as compared to femoral access (OR 0.53, 95% CI 0.42–0.67, I2=3.3%) with a number needed to treat of 92. Findings were consistent regardless clinical features and procedure performed, with the only exception of an increased benefit of the radial access in patients with chronic coronary syndrome (p forinteraction=0.005). The risk for all-cause mortality (OR 0.73, 95% CI 0.61–0.89, I2=0%) and vascular complication (OR 0.32, 95% CI 0.23–0.44, I2=16.7%) was significantly lower in the radial compared to femoral access group. Conclusions In patients undergoing coronary angiography with or without PCI, radial compared to femoral access did not reduce the risk of stroke and myocardial infarction, with no impact on the effect estimates of clinical presentation, age, gender, or subsequent PCI. Whereas, radial access is associated with a significant risk reduction of major bleeding as compared to femoral access. The benefit favoring radial access is of important clinical relevance in view of the relatively low number needed to treat to prevent a major bleeding and the significant impact on mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Duration of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Treated With New Generation Stents: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen-Jiao Zhang ◽  
Xuan Qiao ◽  
Wen-Fen Guo ◽  
Xi-Ying Liang ◽  
Yan Li ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Randomized Controlled Trials ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Controlled Trials ◽  
Target Vessel Revascularization ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
New Generation

Background and Objective: The optimum duration of dual antiplatelet therapy (DAPT) remains uncertain in patients with acute coronary syndrome treated with new generation stents. This meta-analysis was performed to investigate ischemia and bleeding outcomes with different DAPT strategies.Methods: PubMed, Embase, Cochrane and Web of science from inception to May 27, 2020, were systematically searched. Randomized controlled trials were included to compare short-term (6 months or less) with standard (12 months) DAPT in patients with acute coronary syndrome treated with new generation stents. The primary endpoints were myocardial infarction, definite or probable stent thrombosis and major bleeding. The secondary endpoints included all-cause death, cardiovascular death, stroke, target vessel revascularization and net adverse clinical events. Random effect model and fixed effect model were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each endpoint.Results: Four randomized controlled trials and seven subgroup analyses of larger randomized controlled trials, including a total of 21,344 patients with acute coronary syndrome, met our inclusion criteria. The shorter DAPT was associated with significantly lower major bleeding compared with the standard DAPT (OR 0.71, 95% CI 0.56–0.90, P = 0.005, I2 = 25%), while without increasing the risk of myocardial infarction (OR 1.18, 0.88–1.58, P = 0.28, I2 = 20%), definite or probable stent thrombosis (OR 1.60, 0.98–2.59, P = 0.06, I2 = 0%). No significantly difference was observed in the risk of all-cause death (OR 0.96, 0.72–1.27, P = 0.76, I2 = 2%), cardiovascular death (OR 0.91, 0.62–1.33, P = 0.62, I2 = 0%), stroke (OR 0.84, 0.54–1.30, P = 0.43, I2 = 0%), target vessel revascularization (OR 1.14, 0.84–1.55, P = 0.41, I2 = 8%), and net adverse clinical events (OR 0.93, 0.80–1.07, P = 0.3, I2 = 18%) between the two groups.Conclusions: In patients with acute coronary syndrome treated with new generation stents, the shorter DAPT leads to a marked reduction in the risk of major bleeding compared with the standard DAPT. This benefit is achieved without increasing the risk of mortality or ischemic outcomes. The study protocol was registered in PROSPERO (CRD42020189871).

scholarly journals Antithrombotic Treatment in Cryptogenic Stroke Patients With Patent Foramen Ovale

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3135-3140 ◽  
Author(s):  
Dimitrios Sagris ◽  
Georgios Georgiopoulos ◽  
Kalliopi Perlepe ◽  
Konstantinos Pateras ◽  
Eleni Korompoki ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Controlled Trials ◽  
Foramen Ovale ◽  
Antiplatelet Treatment ◽  
Randomized Controlled ◽  
Ischemic Attack

Background and Purpose— It is unclear whether treatment with anticoagulants or antiplatelets is the optimal strategy in patients with stroke or transient ischemic attack of undetermined cause and patent foramen ovale that is not percutaneously closed. We aimed to perform a systematic review and meta-analysis of randomized controlled trials to compare anticoagulant or antiplatelet treatment in this population. Methods— We searched PubMed until July 16, 2019 for trials comparing anticoagulants and antiplatelet treatment in patients with stroke/transient ischemic attack and medically treated patent foramen ovale using the terms: “cryptogenic or embolic stroke of undetermined source” and “stroke or cerebrovascular accident or transient ischemic attack” and “patent foramen ovale or patent foramen ovale or paradoxical embolism” and “trial or study” and “antithrombotic or anticoagulant or antiplatelet.” The outcomes assessed were stroke recurrence, major bleeding, and the composite end point of stroke recurrence or major bleeding. We used 3 random-effects models: (1) a reference model based on the inverse variance method with the Sidik and Jonkman heterogeneity estimator; (2) a strict model, implementing the Hartung and Knapp method; and (3) a commonly used Bayesian model with a prior that assumes moderate to large between-study variance. Results— Among 112 articles identified in the literature search, 5 randomized controlled trials were included in the meta-analysis (1720 patients, mean follow-up 2.3±0.5 years). Stroke recurrence occurred at a rate of 1.73 per 100 patient-years in anticoagulant-assigned patients and 2.39 in antiplatelet-assigned patients (hazard ratio, 0.68; 95% CI, 0.32–1.48 for the Sidik and Jonkman estimator). Major bleeding occurred at a rate of 1.16 per 100 patient-years in anticoagulant-assigned patients and 0.68 in antiplatelet-assigned patients (hazard ratio, 1.61; 95% CI, 0.72–3.59 for the Sidik and Jonkman estimator). The composite outcome occurred in 52 anticoagulant-assigned and 54 antiplatelet-assigned patients (odds ratio, 1.05; 95% CI, 0.65–1.70 for the Sidik and Jonkman estimator). Conclusions— We cannot exclude a large reduction of stroke recurrence in anticoagulant-assigned patients compared with antiplatelet-assigned, without significant differences in major bleeding. An adequately powered randomized controlled trial of a non–vitamin K antagonist versus aspirin is warranted.

ID: 24: BENEFITS AND RISKS OF WARFARIN WITH AND WITHOUT ASPIRIN IN PATIENTS WITH CORONARY ARTERY DISEASE OR CEREBROVASCULAR ACCIDENT: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2016 ◽  
Vol 64 (4) ◽  
pp. 934.2-934
Author(s):  
A Deshpande ◽  
K Patel ◽  
MB Rothberg ◽  
V Pasupuleti ◽  
G Alreja ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Randomized Controlled Trials ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Intracranial Bleeding ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Artery Disease

BackgroundPrevious studies have shown that secondary prophylaxis of non-embolic stroke remains challenging. Randomized controlled trials (RCTs) evaluating warfarin with or without aspirin to prevent stroke have yielded mixed results. We conducted a meta-analysis of RCTs to evaluate the efficacy of warfarin (with and without aspirin) in patients with coronary artery disease (CAD) or ischemic stroke/ transient ischemic attack (TIA).MethodsWe searched 6 electronic databases published from 1980–2014. RCTs reporting the benefits (reduced incidence of stroke) and risks (mortality, intracranial bleeds, major and minor bleeds) of warfarin (with and without aspirin) therapy were included. Trials were stratified by intensity of the therapeutic international normalized ratio (INR): low (INR<2), intermediate (INR 2–3) and high (INR>3). Risk ratios (RRs) were pooled using random-effects models.ResultsTwenty-five RCTs (30,939 patients) met our inclusion criteria. Intermediate intensity warfarin with aspirin compared with aspirin alone significantly reduced the risk of secondary strokes [RR 0.48, 95% confidence interval (CI) 0.29–0.80], but increased the risk of major bleeding (RR 2.54, CI 1.70–3.79); there were no significant differences in mortality (RR 1.00, CI 0.80–1.25) and intracranial bleeding (RR 3.03, CI 0.48–19.20). Intermediate intensity warfarin without aspirin compared with aspirin alone, significantly increased major bleeding (RR 2.11, CI 1.45–3.06); there were no significant differences for stroke (RR 0.84, CI 0.66–1.08), mortality (RR1.21, CI 0.90–1.63) and intracranial bleeding (RR 1.87, CI 0.94–3.70).ConclusionsUse of intermediate intensity warfarin with aspirin reduced the risk of stroke at the price of increased bleeding. Most anticoagulation increased the risk of major bleeding with no effect on mortality. Studies with oral anticoagulants with aspirin for secondary prevention should be considered.

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