Abstract 9796: Transradial versus Transfemoral Approach for Coronary Angiography and Intervention in Elderly: A Systemic Review & Meta-analysis

Abstract

Background: Limited information is available about the safety & efficacy of transradial (TR) versus transfemoral (TF) approach for percutaneous coronary angiography & interventions in the elderly. Objective: The authors Aimed to conduct first ever comprehensive meta-analysis to evaluate the safety & efficacy of TR versus TF approach in the elderly. Methods: The PubMed, Embase & CINAHL were searched for studies evaluating TR versus TF approach in the elderly (age≥75 years). The Stata software package was used to conduct more conservative random effect meta-analysis. Primary end point was access site complications (hematoma, pseudoaneurysm or need for access site surgery). Results: Twelves studies (4 randomized & 8 observational) comprising 5636 patients met inclusion criteria for the review (Figure). The primary end point of access site complications was significantly lower in the TR group versus TF group (RR 0.23, 95% CI 0.15-0.34). The secondary end points of bleeding requiring blood transfusion (RR 0.49, 95% CI 0.25-0.94) and any access site bleeding (0.26, 95% 0.17-0.40) were also significantly lower in TR group compared to TF. However, TR group had higher access site cross-over rate requiring alternate access site (RR 4.26, 95% CI 1.59-11.39). Two groups had similar rates of myocardial infarction (RR 0.81, 95% CI 0.54-1.21), stroke (RR 1.21, 95% CI 0.30-4.79), major adverse cardiovascular events (RR 0.84, 95% CI 0.64-1.11), in-hospital mortality (RR 0.75, 95% CI 0.29-1.96) & 30 day mortality (RR 0.79, 95% CI 0.57-1.08). The randomized and observational studies yielded concordant pooled effect estimates. Conclusions: Transradial approach, when feasible, significantly reduces the need for blood transfusions and access site complications in the elderly. A careful selection of access site is required due to high cross over rate in the TR approach. The benefit of TR approach may not extend beyond access site complications and bleeding.