经皮冠状动脉介入治疗中急性冠状动脉综合征患者经桡动脉入路与经股动脉入路的比较：一项随机对照试验的更新荟萃分析。

Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials.

机构信息

Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India.

Adjunct Faculty, Department of Engineering and design, Indian Institute of Technology-Madras, Chennai, India.

出版信息

PLoS One. 2022 Apr 28;17(4):e0266709. doi: 10.1371/journal.pone.0266709. eCollection 2022.

INTRODUCTION

Trans-radial approach (TRA) is recommended over trans-femoral approach (TFA) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We intended to study the effect of access on all-cause mortality.

METHODS AND RESULTS

We searched PubMed and EMBASE for randomized studies on patients with ACS undergoing PCI. The primary outcome was all-cause mortality at 30-days. The secondary outcomes included in-hospital mortality, major adverse cardiac or cerebrovascular event (MACE) as defined by the study, net adverse clinical event (NACE), non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, study-defined major bleeding, and minor bleeding, vascular complications, hematoma, pseudoaneurysm, non-access site bleeding, need for transfusion, access site cross-over, contrast volume, procedure duration, and hospital stay duration. We studied 20,122 ACS patients, including 10,037 and 10,085 patients undergoing trans-radial and trans-femoral approaches, respectively. We found mortality benefit in patients with ACS for the trans-radial approach [(1.7% vs. 2.3%; RR: 0.75; 95% CI: 0.62-0.91; P = 0.004; I2 = 0%). Out of 10,465 patients with STEMI, 5,189 patients had TRA and 5,276 had TFA procedures. A similar benefit was observed in patients with STEMI alone [(2.3% vs. 3.3%; RR: 0.71; 95% CI: 0.56-0.90; P = 0.004; I2 = 0%). We observed reduced MACE, NACE, major bleeding, vascular complications, and pseudoaneurysms. No difference in re-infarction, stroke, and serious bleeding requiring blood transfusions were noted. We noticed a small decrease in contrast volume(ml) {mean difference (95% CI): -4.6 [-8.5 to -0.7]}, small but significantly increase in procedural time {mean difference (95% CI) 1.2 [0.1 to 2.3]}and fluoroscopy time {mean difference (95% CI) 0.8 [0.3 to1.4] min} in the trans-radial group.

CONCLUSION

TRA has significantly reduced 30-day all-cause mortality among patients undergoing PCI for ACS. TRA should be the preferred vascular access in patients with ACS.

介绍

在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，经桡动脉入路（TRA）优于经股动脉入路（TFA）。我们旨在研究入路对全因死亡率的影响。

方法和结果

我们在 PubMed 和 EMBASE 上搜索了接受 PCI 的 ACS 患者的随机研究。主要结局为 30 天全因死亡率。次要结局包括住院死亡率、研究定义的主要心脏或脑血管事件（MACE）、净不良临床事件（NACE）、非致死性心肌梗死、非致死性卒中和支架血栓形成、研究定义的大出血和轻微出血、血管并发症、血肿、假性动脉瘤、非入路部位出血、需要输血、入路部位交叉、造影剂体积、手术时间和住院时间。我们研究了 20122 例 ACS 患者，其中 10037 例和 10085 例分别接受经桡动脉和经股动脉入路。我们发现 ACS 患者经桡动脉入路死亡率获益[1.7%比 2.3%；RR：0.75；95%CI：0.62-0.91；P=0.004；I2=0%]。在 10465 例 STEMI 患者中，5189 例患者接受 TRA，5276 例患者接受 TFA 治疗。单独 STEMI 患者也观察到类似的获益[2.3%比 3.3%；RR：0.71；95%CI：0.56-0.90；P=0.004；I2=0%]。我们观察到 MACE、NACE、大出血、血管并发症和假性动脉瘤减少。再梗死、卒中和需要输血的严重出血无差异。我们注意到造影剂体积（ml）有少量减少[平均差异（95%CI）：-4.6[-8.5 至-0.7]，手术时间[平均差异（95%CI）：1.2[0.1 至 2.3]）和透视时间[平均差异（95%CI）：0.8[0.3 至 1.4] min]有小但显著增加，桡动脉组。