Rigattieri Stefano, Sciahbasi Alessandro, Ratib Karim, Alonzo Alessandro, Cox Nicholas, Chodór Piotr, Berni Andrea, Fedele Silvio, Pugliese Francesco R, Cooper Christopher J, Louvard Yves, Nolan James, Rao Sunil V
Interventional Cardiology Unit and Emergency Department, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157, Rome, Italy.
J Invasive Cardiol. 2016 Dec;28(12):473-479. Epub 2016 Sep 15.
Periprocedural bleedings, often related to vascular access site, represent an important drawback of percutaneous coronary procedures and are associated with worse outcomes. Radial access (RA) and, potentially, femoral access (FA) with vascular closure device (VCD) are useful strategies in order to mitigate periprocedural bleedings; nevertheless, their relative efficacy is largely undetermined. We aimed to perform a systematic review and meta-analysis of available studies comparing the efficacy of RA and FA with hemostasis by VCD (FA + VCD) on the reduction of access-site complications and/or periprocedural bleedings.
Published studies reporting outcomes on access-site complications and periprocedural bleedings were included in the analysis. Data were extracted by two independent reviewers; odds ratio (OR) and 95% confidence interval (CI) were calculated by random-effects model and were used as summary statistics.
We included in the analysis 13 studies, of which 5 were randomized. Access-site complications were reported by 11 studies, amounting to 157,031 patients (77,713 in the RA group and 79,318 in the FA + VCD group), whereas periprocedural bleedings were reported by 12 studies, amounting to 600,196 patients (137,277 in the RA group and 462,919 in the FA + VCD group). RA was associated with a significant reduction in access-site complications (OR, 0.25; 95% CI ,0.21-0.31; P<.001) and periprocedural bleedings (OR, 0.40; 95% CI, 0.34-0.48; P<.001) as compared with FA + VCD; the results were consistent among randomized and observational studies.
This meta-analysis shows that RA is superior to FA + VCD in the reduction of access-site complications and periprocedural bleedings.
围手术期出血通常与血管穿刺部位有关，是经皮冠状动脉介入手术的一个重要缺点，且与较差的预后相关。桡动脉入路（RA）以及可能使用血管闭合装置（VCD）的股动脉入路（FA）是减轻围手术期出血的有用策略；然而，它们的相对疗效在很大程度上尚未确定。我们旨在对现有研究进行系统评价和荟萃分析，比较RA和使用VCD止血的FA（FA + VCD）在减少穿刺部位并发症和/或围手术期出血方面的疗效。
分析纳入了报告穿刺部位并发症和围手术期出血结局的已发表研究。数据由两名独立的审阅者提取；采用随机效应模型计算比值比（OR）和95%置信区间（CI），并将其用作汇总统计量。
我们在分析中纳入了13项研究，其中5项为随机对照研究。11项研究报告了穿刺部位并发症，涉及157,031例患者（RA组77,713例，FA + VCD组79,318例），而12项研究报告了围手术期出血，涉及600,196例患者（RA组137,277例，FA + VCD组462,919例）。与FA + VCD相比，RA与穿刺部位并发症（OR，0.25；95% CI，0.21 - 0.31；P <.001）和围手术期出血（OR，0.40；95% CI，0.34 - 0.48；P <.001）的显著减少相关；随机对照研究和观察性研究的结果一致。
这项荟萃分析表明，在减少穿刺部位并发症和围手术期出血方面，RA优于FA + VCD。
