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.
PLoS One. 2022 Apr 28;17(4):e0266709. doi: 10.1371/journal.pone.0266709. eCollection 2022.
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.
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.
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.
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。
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。
TRA 显著降低了接受 ACS 经皮冠状动脉介入治疗患者的 30 天全因死亡率。TRA 应成为 ACS 患者的首选血管入路。
