Rigattieri Stefano, Sciahbasi Alessandro, Brilakis Emmanouil S, Burzotta Francesco, Rathore Sudhir, Pugliese Francesco R, Fedele Silvio, Ziakas Antonios G, Zhou Yu J, Guzman Luis A, Anderson Richard A
Emergency Department, Sandro Pertini Hospital, Rome, Italy.
Emergency Department, Sandro Pertini Hospital, Rome, Italy.
Am J Cardiol. 2016 Apr 15;117(8):1248-55. doi: 10.1016/j.amjcard.2016.01.016. Epub 2016 Jan 28.
Cardiac catheterization through the radial artery approach (RA) has been shown to significantly reduce access-site complications compared with the femoral artery approach (FA) in many clinical settings. However, in the subset of patients with previous coronary artery bypass grafting (CABG), optimal vascular access site for coronary angiography and intervention is still a matter of debate. We aimed to perform a systematic review and meta-analysis of available studies comparing RA with FA in patients with previous CABG. Data were extracted by two independent reviewers; weighted mean differences and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. Summary statistics were calculated by random-effects model using Review Manager 5.3 software. The meta-analysis included 1 randomized and 8 nonrandomized studies, with a total of 2,763 patients. Compared with FA, RA required similar procedural time (mean difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time (mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p = 0.75) and was associated with similar rate of procedural failure (OR 1.32, 95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In conclusion, the present meta-analysis suggests that in patients with previous CABG undergoing coronary procedures, RA, compared with FA, is associated with increased crossover rate but may reduce access-site complications.
在许多临床情况下，经桡动脉途径（RA）进行心脏导管插入术已被证明与经股动脉途径（FA）相比，能显著减少穿刺部位并发症。然而，在既往有冠状动脉旁路移植术（CABG）的患者亚组中，冠状动脉造影和介入治疗的最佳血管穿刺部位仍存在争议。我们旨在对比较既往CABG患者中RA与FA的现有研究进行系统评价和荟萃分析。由两名独立的审阅者提取数据；对于连续变量结果计算加权平均差和95%置信区间（CI），而对于二分变量结果计算比值比（OR）和95%CI。使用Review Manager 5.3软件通过随机效应模型计算汇总统计量。荟萃分析纳入了1项随机研究和8项非随机研究，共2763例患者。与FA相比，RA所需的手术时间相似（平均差3.24分钟，95%CI -1.76至8.25，p = 0.20）、透视时间相似（平均差0.62分钟，95%CI -0.83至2.07，p = 0.40）以及造影剂用量相似（平均差 -2.58 ml，95%CI -18.36至13.20，p = 0.75），并且与相似的手术失败率相关（OR 1.32，95%CI 0.63至2.80，p = 0.46）、更高的转换至另一血管穿刺的发生率（OR 7.0，95%CI 2.74至17.87，p <0.0001）以及更低的穿刺部位并发症风险（OR 0.46，95%CI 0.26至0.80，p = 0.006）。总之，本荟萃分析表明，在既往有CABG且接受冠状动脉手术的患者中，与FA相比，RA与更高的转换率相关，但可能减少穿刺部位并发症。
