Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
Catheter Cardiovasc Interv. 2022 Feb;99(2):462-471. doi: 10.1002/ccd.30010. Epub 2021 Nov 14.
The optimal access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) continues to be debated.
We performed a random effects frequentist and Bayesian meta-analysis of 4 randomized trials and 18 observational studies, including 60,192 patients with prior CABG (27,236 in the radial group; 32,956 in the femoral group) that underwent cardiac catheterization. Outcomes included (1) access-site complications, (2) crossover to a different vascular access, (3) procedure time, and (4) contrast volume. Mean differences (MD) and 95% confidence interval (CI) were calculated for continuous outcomes and odds ratios (OR) and 95% CI for binary outcomes.
Among randomized trials, crossover (OR: 7.63; 95% CI: 2.04, 28.51; p = 0.003) was higher in the radial group, while access site complications (OR: 0.96; 95% CI: 0.34, 2.87; p = 0.94) and contrast volume (MD: 15.08; 95% CI: -10.19, 40.35; p = 0.24) were similar. Among observational studies, crossover rates were higher (OR: 5.09; 95% CI: 2.43, 10.65; p < 0.001), while access site complication rates (OR: 0.52; 95% CI: 0.30, 0.89; p = 0.02) and contrast volume (MD: -7.52; 95% CI: -13.14, -1.90 ml; p = 0.009) were lower in the radial group. Bayesian analysis suggested that the odds of a difference existing between radial and femoral are small for all endpoints except crossover to another access site.
In a frequentist and Bayesian meta-analysis of patients with prior CABG undergoing coronary catheterization, radial access was associated with lower incidence of vascular access complications and lower contrast volume but also higher crossover rate.
对于既往接受过冠状动脉旁路移植术（CABG）的患者，心脏导管插入术的最佳入路部位仍存在争议。
我们对 4 项随机试验和 18 项观察性研究进行了随机效应频率派和贝叶斯荟萃分析，共纳入 60192 例既往接受过 CABG（桡动脉组 27236 例，股动脉组 32956 例）行心脏导管插入术的患者。结局包括（1）入路部位并发症，（2）交叉至另一种血管入路，（3）手术时间和（4）造影剂用量。对于连续性结局，计算均数差（MD）和 95%置信区间（CI）；对于二分类结局，计算比值比（OR）和 95%CI。
在随机试验中，桡动脉组的交叉率更高（OR：7.63；95%CI：2.04，28.51；p=0.003），而桡动脉组的入路部位并发症（OR：0.96；95%CI：0.34，2.87；p=0.94）和造影剂用量（MD：15.08；95%CI：-10.19，40.35；p=0.24）相似。在观察性研究中，交叉率更高（OR：5.09；95%CI：2.43，10.65；p<0.001），而桡动脉组的入路部位并发症发生率（OR：0.52；95%CI：0.30，0.89；p=0.02）和造影剂用量（MD：-7.52；95%CI：-13.14，-1.90ml；p=0.009）较低。贝叶斯分析表明，除交叉至另一种血管入路外，桡动脉与股动脉之间所有结局的差异概率均较小。
在一项对既往接受过 CABG 行冠状动脉导管插入术的患者进行的频率派和贝叶斯荟萃分析中，桡动脉入路与较低的血管入路并发症发生率和较低的造影剂用量相关，但交叉率较高。
