Lueg Julia, Schulze Daniel, Stöhr Robert, Leistner David M
Deutsches Herzzentrum der Charité, Klinik für Kardiologie und Angiologie, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Clin Res Cardiol. 2024 Sep 17. doi: 10.1007/s00392-024-02505-3.
Distal radial access (DRA) represents a promising alternative to conventional proximal radial access (PRA) for coronary angiography. Substantial advantages regarding safety and efficacy have been suggested for DRA, but the ideal access route remains controversial.
The aim of this study was to compare safety, efficacy and feasibility of DRA to PRA.
National Library of Medicine PubMed, Web of Science, clinicaltrials.gov and Cochrane Library were systematically searched for randomized controlled trials and registry studies comparing DRA and PRA that were published between January 1, 2017 and April, 2024. Primary endpoint was the rate of radial artery occlusion (RAO). Secondary endpoints were access failure, access time, procedure time, arterial spasm, hematoma, and hemostasis time. Data extraction was performed by two independent investigators. Relative risks were aggregated using a random effects model. We applied meta-analytic regression to assess study characteristic variables as possible moderators of the study effects.
44 studies with a total of 21,081 patients were included. We found a significantly lower rate of RAO after DRA (DRA 1.28%, PRA 4.76%, p < .001) with a 2.92 times lower risk compared to the proximal approach (Log Risk Ratio = -1.07, p < .001). Conversely, the risk for access failure was 2.42 times higher for DRA compared to PRA (Log Risk Ratio = 0.88, p < .001).
In this largest meta-analysis to date, we were able to show that rates of RAO are reduced with DRA compared to conventional PRA. This suggests DRA is a safe alternative to PRA.
对于冠状动脉造影，桡动脉远端入路（DRA）是传统桡动脉近端入路（PRA）的一种有前景的替代方法。DRA在安全性和有效性方面具有显著优势，但理想的入路途径仍存在争议。
本研究旨在比较DRA与PRA的安全性、有效性和可行性。
系统检索美国国立医学图书馆的PubMed、科学网、ClinicalTrials.gov和考科蓝图书馆，查找2017年1月1日至2024年4月期间发表的比较DRA和PRA的随机对照试验和注册研究。主要终点是桡动脉闭塞（RAO）率。次要终点是入路失败、入路时间、手术时间、动脉痉挛、血肿和止血时间。由两名独立研究人员进行数据提取。使用随机效应模型汇总相对风险。我们应用荟萃分析回归来评估研究特征变量作为研究效应的可能调节因素。
纳入44项研究，共21081例患者。我们发现DRA后RAO发生率显著更低（DRA为1.28%，PRA为4.76%，p < 0.001），与近端入路相比风险低2.92倍（对数风险比 = -1.07，p < 0.001）。相反，DRA入路失败的风险比PRA高2.42倍（对数风险比 = 0.88，p < 0.001）。
在这项迄今为止最大规模的荟萃分析中，我们能够表明与传统PRA相比，DRA可降低RAO发生率。这表明DRA是PRA的一种安全替代方法。
