Abstract 10281: Meta-Analysis of Nitroglycerin’s Efficacy in Preventing the Incidence of Radial Artery Spasm and Occlusion During Trans-Radial Catheterization

Abstract

Introduction. Trans-radial artery (TRA) becomes the most common entry route for cardiac catheterization. However, it may cause radial artery spasm (RAS) and subsequent radial artery occlusion (RAO). We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of different administration routes of nitroglycerin in reducing RAS and RAO compared to placebo in adult patients undergoing TRA cardiac catheterization. Methods. We searched Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL for RCTs up to April 23, 2022. The outcomes of interest were the incidence of RAS or RAO. Pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) in a fixed-effects model was generated using RevMan Software (Version 5.4). We evaluated heterogeneity using I-square and Chi-square tests. Results. Eleven trials with 5,814 patients were included. Compared to placebo, the overall results showed that nitroglycerin was effective in preventing RAS (RR: 0.71 with 95% CI [0.59, 0.84], p= 0.0001), and RAO (RR: 0.74 with 95% CI [0.58, 0.94], p= 0.02). However, subgroup analysis according to the route of administration showed statistically significant result with subcutaneous nitroglycerin in prevention both RAS (RR: 0.57 with 95% CI [0.43, 0.77], p= 0.0003) and RAO (RR: 0.39 with 95% CI [0.16, 0.98, p= 0.05) but not intra-arterial nitroglycerine for RAS ((RR: 0.8 with 95% CI [0.63, 1.02], p= 0.07) and RAO (RR: 0.78 with 95% CI [0.6, 1.01], p= 0.06)), neither topical nitroglycerine for RAS ((RR: 0.73 with 95% CI [0.42, 1.24], p= 0.24). Conclusion. Our meta-analysis showed that subcutaneous nitroglycerin administration for TRA catheterization may prevent RAS and subsequent RAO compared to placebo. In contrast, intra-atrial and topical nitroglycerin have non-significant outcomes. Figure 1: Forest plot of the primary outcomes sub-grouped by route of administration (A- RAS, B- RAO). I2: I-squared; CI: confidence interval.