PMID- 27537543 OWN - NLM STAT- MEDLINE DCOM- 20171009 LR - 20181202 IS - 1874-1754 (Electronic) IS - 0167-5273 (Linking) VI - 222 DP - 2016 Nov 1 TI - Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: Systematic review, collaborative meta-analysis, and meta-regression. PG - 1031-1039 LID - S0167-5273(16)31624-2 [pii] LID - 10.1016/j.ijcard.2016.07.228 [doi] AB - BACKGROUND: Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients. METHODS: We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients. Included studies had to meet the following criteria: 1) enrolling patients with NSTE-ACS undergoing invasive management; 2) reporting outcomes with respect to RA as compared with femoral access (FA); 3) reporting short-term (procedural, in-hospital and up to 30-day) or long-term clinical outcomes. Studies were pooled with fixed and random effects models and heterogeneity was investigated by weighted meta-regression. RESULTS: Eleven studies were included encompassing 131.339 patients, 46.451 receiving RA and 84.888 receiving FA. Thirty-day mortality and MACE were lower with RA (p<0.001 with fixed effects, p=NS with random effects model), but these results depended on one large observational database. Major bleeding was consistently reduced by RA (p<0.001), albeit an inverse relationship with the proportion of patients in each study receiving FA and experiencing major bleeding was evident. The association of RA with reduced long-term mortality was of borderline significance (p=0.054 with random-effects, p=0.001 with fixed-effect model) and also depended on major bleeding in FA patients. CONCLUSIONS: RA is associated with better outcomes as compared with FA in NSTE-ACS, although this observation is influenced by nonrandomized comparisons. Large heterogeneity exists among studies. REGISTRATION: This study is registered in the PROSPERO database (CRD42015029459). CI - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Ando, Giuseppe AU - Ando G AD - Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. Electronic address: giuseppeando1975@gmail.com. FAU - Porto, Italo AU - Porto I AD - Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. FAU - Montalescot, Gilles AU - Montalescot G AD - ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitie-Salpetriere (AP-HP), Paris, France. FAU - Bolognese, Leonardo AU - Bolognese L AD - Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy. FAU - Trani, Carlo AU - Trani C AD - Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. FAU - Oreto, Giuseppe AU - Oreto G AD - Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. FAU - Harrington, Robert A AU - Harrington RA AD - Department of Medicine, Stanford University, Stanford, CA, USA. FAU - Bhatt, Deepak L AU - Bhatt DL AD - Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20160730 PL - Netherlands TA - Int J Cardiol JT - International journal of cardiology JID - 8200291 SB - IM MH - Acute Coronary Syndrome/diagnostic imaging/epidemiology/*surgery MH - Coronary Angiography/methods MH - Humans MH - Observational Studies as Topic/methods MH - Percutaneous Coronary Intervention/*methods MH - Radial Artery/diagnostic imaging/*surgery MH - Randomized Controlled Trials as Topic/methods MH - ST Elevation Myocardial Infarction/diagnostic imaging/epidemiology/*surgery OTO - NOTNLM OT - Acute coronary syndrome OT - Percutaneous coronary intervention OT - Radial access EDAT- 2016/08/19 06:00 MHDA- 2017/10/11 06:00 CRDT- 2016/08/19 06:00 PHST- 2016/05/10 00:00 [received] PHST- 2016/07/29 00:00 [accepted] PHST- 2016/08/19 06:00 [entrez] PHST- 2016/08/19 06:00 [pubmed] PHST- 2017/10/11 06:00 [medline] AID - S0167-5273(16)31624-2 [pii] AID - 10.1016/j.ijcard.2016.07.228 [doi] PST - ppublish SO - Int J Cardiol. 2016 Nov 1;222:1031-1039. doi: 10.1016/j.ijcard.2016.07.228. Epub 2016 Jul 30.