PMID- 27863361
OWN - NLM
STAT- MEDLINE
DCOM- 20171103
LR  - 20171103
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 228
DP  - 2017 Feb 1
TI  - Transradial approach for coronary angiography and intervention in the elderly: A 
      meta-analysis of 777,841 patients.
PG  - 45-51
LID - S0167-5273(16)33684-1 [pii]
LID - 10.1016/j.ijcard.2016.11.207 [doi]
AB  - BACKGROUND: Studies showing an advantage of transradial approach (TR) for 
      coronary angiography and intervention (PCI) compared to the transfemoral approach 
      (TF) predominantly included a younger population. Therefore, we conducted a 
      meta-analysis of published studies to determine the efficacy of TR in the elderly 
      population. METHODS AND RESULTS: A comprehensive search identified 16 studies [3 
      randomized controlled studies, 13 observational] comprising 777,841 elderly 
      patients undergoing PCI. TR was used in 99,201 patients and TF in 678,640 
      patients. The results from observational studies showed that TR was associated 
      with a lower rate of vascular complications (0.4% vs. 0.8%, OR 0.36, 95% CI 
      0.30-0.44), stroke (0.3% vs. 0.4%, OR 0.81, 95% CI 0.66-1.0) and death (2.0% vs. 
      2.2%, OR 0.51, 95% CI 0.41-0.63). RCTs confirmed findings from observational 
      studies for both significant reduction in vascular complications (2.7% vs. 7%, OR 
      0.37, 95% CI 0.23-0.60) and stroke (0.4% vs. 1.4%, OR 0.31, 95% CI 0.10-0.97) but 
      showed no effect on mortality (3.3% vs. 2.8%, OR 1.20, 95% CI 0.69-2.09). 
      However, among patients with ST elevation myocardial infarction (STEMI), TR was 
      associated with a mortality benefit (5% vs. 7%, OR 0.48, 95% CI 0.25-0.90, 
      p=0.02). Access site crossover rate was higher for TR compared to the TF approach 
      (11% vs. 3%, p=0.0003) but there was no difference in contrast media use, 
      procedure duration, fluoroscopy time and door to balloon time for STEMI. 
      CONCLUSION: TR for PCI in the elderly is associated with a reduced risk of 
      stroke, lower rate of vascular complications overall and a mortality benefit for 
      patients presenting with STEMI. The access site cross rate for TR is higher 
      compared to TF but remains acceptably low. TR should be the preferred strategy 
      for PCI in the elderly to optimize clinical benefit in this high-risk group.
CI  - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved.
FAU - Alnasser, Sami M
AU  - Alnasser SM
AD  - St. Michael's Hospital, Toronto, Canada.
FAU - Bagai, Akshay
AU  - Bagai A
AD  - St. Michael's Hospital, Toronto, Canada.
FAU - Jolly, Sanjit S
AU  - Jolly SS
AD  - Hamilton General Hospital, Hamilton, Ontario, Canada.
FAU - Cantor, Warren J
AU  - Cantor WJ
AD  - Southlake Regional Health Centre, Newmarket, Ontario, Canada.
FAU - Dehghani, Payam
AU  - Dehghani P
AD  - Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada.
FAU - Rao, Sunil V
AU  - Rao SV
AD  - Duke Clinical Research Institute, Durham, NC, United States.
FAU - Cheema, Asim N
AU  - Cheema AN
AD  - St. Michael's Hospital, Toronto, Canada. Electronic address: cheemaa@smh.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20161110
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aged
MH  - Catheterization, Peripheral/*methods
MH  - Coronary Angiography/*methods
MH  - *Coronary Disease/diagnosis/mortality/surgery
MH  - Humans
MH  - Percutaneous Coronary Intervention/*methods
MH  - *Postoperative Complications/epidemiology/etiology/prevention & control
MH  - Radial Artery/*surgery
MH  - Risk Adjustment
MH  - Survival Analysis
OTO - NOTNLM
OT  - Coronary angiography
OT  - Coronary intervention
OT  - Elderly
OT  - Radial approach
EDAT- 2016/11/20 06:00
MHDA- 2017/11/04 06:00
CRDT- 2016/11/19 06:00
PHST- 2016/08/26 00:00 [received]
PHST- 2016/11/06 00:00 [accepted]
PHST- 2016/11/20 06:00 [pubmed]
PHST- 2017/11/04 06:00 [medline]
PHST- 2016/11/19 06:00 [entrez]
AID - S0167-5273(16)33684-1 [pii]
AID - 10.1016/j.ijcard.2016.11.207 [doi]
PST - ppublish
SO  - Int J Cardiol. 2017 Feb 1;228:45-51. doi: 10.1016/j.ijcard.2016.11.207. Epub 2016 
      Nov 10.