Meta-Analysis Comparing Distal Radial Versus Traditional Radial Percutaneous Coronary Intervention or Angiography

Abstract

Data comparing outcomes of distal radial (DR) and traditional radial (TR) access of coronary angiography and percutaneous coronary intervention (PCI) are limited. Online databases including Medline and Cochrane Central databases were explored to identify studies that compared DR and TR access for PCI. The primary outcome was the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included access site hematoma, access site bleeding, access site pain, radial artery spasm, radial artery dissection, and crossover. Unadjusted odds ratios (ORs) with a random-effect model, 95% confidence interval (CI), and p <0.05 were used for statistical significance. Metaregression was performed for 16 studies with 9,973 (DR 4,750 and TR 5,523) patients were included. Compared with TR, DR was associated with lower risk of RAO (OR 0.51, 95% CI 0.29 to 0.90, I2=42.6%, p=0.02). RAO was lower in DR undergoing coronary angiography rather than PCI. Access failure rate (OR 1.77, 95% CI 0.69 to 4.55, I2 87.36%, p=0.24), access site hematoma (OR 1.11, 95% CI 0.68 to 1.83, I2 0%, p=0.68), access site pain (OR 2.22, 95% CI 0.28 to 17.38, I2 0%, p=0.45), access site bleeding (OR 1.11, 95% CI 0.16 to 7.62, I2 85.11%, p=0.91), radial artery spasm (OR 0.79, 95% CI 0.49 to 1.29, I2 0%, p=0.35), radial artery dissection (OR 1.63, 95% CI 0.46 to 5.84, I2 0%, p=0.45), and crossover (OR 1.54, 95% CI 0.64 to 3.70, I2 25.48%, p=0.33) did not show any significant difference. DR was associated with lower incidence RAO when compared with TR, whereas other procedural-related complications were similar.