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.

Stefano Rigattieri,Francesco Cava,Ernesto Cristiano,Massimo Volpe,Andrea Berni,Francesca Giovannelli,Domenico Maria Zardi,Barbara Citoni,Antonella Tommasino,Michael C Kim

doi:10.1155/2021/9917407

Stefano Rigattieri, Francesco Cava + Show 8 more

Open Access

https://doi.org/10.1155/2021/9917407

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Abstract

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.

Highlights

Several trials and meta-analyses consistently showed better clinical outcomes with radial as compared to femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), mainly because of a striking reduction of bleeding events related to vascular access site [1, 2]
We limited our search to articles published in English language on peerreviewed Journals; the “Similar articles” section of PubMed and references from selected studies were checked. e following clinical end-points were considered for analysis: (1) in-hospital or 30-day mortality for all causes, (2) major bleedings, and (3) major adverse cardiovascular events (MACE)
For studies comparing radial and femoral access in the whole spectrum of acute coronary syndromes, we only considered outcomes relative to the STEMI subgroup. is analysis was planned in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols [8]

Summary

Introduction

Several trials and meta-analyses consistently showed better clinical outcomes with radial as compared to femoral access for primary PCI in patients with ST-elevation myocardial infarction (STEMI), mainly because of a striking reduction of bleeding events related to vascular access site [1, 2]. Bleedings negatively impact prognosis in acute coronary syndromes [3]; several bleeding avoidance strategies, including radial access, femoral vascular closure devices (VCD), and safer antithrombotic drugs, such as bivalirudin, have been adopted in order to improve outcomes [4]. Is change in practice is reflected in randomized trials comparing radial and femoral access, with.

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