TY - JOUR
T1 - Radial versus femoral access in patients with coronary artery bypass surgery
T2 - Frequentist and Bayesian meta-analysis
AU - Nikolakopoulos, Ilias
AU - Vemmou, Evangelia
AU - Xenogiannis, Iosif
AU - Karacsonyi, Judit
AU - Rao, Sunil V.
AU - Romagnoli, Enrico
AU - Tsigkas, Grigorios
AU - Milkas, Anastasios
AU - Velagapudi, Poonam
AU - Alaswad, Khaldoon
AU - Rangan, Bavana V.
AU - Garcia, Santiago
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Dr. Nikolakopoulos: nothing to disclose; Dr. Vemmou: nothing to disclose; Dr. Xenogiannis: nothing to disclose; Dr. Karacsonyi: nothing to disclose; Dr. Rao: nothing to disclose; Dr. Romagnoli: nothing to disclose; Dr. Tsigkas: nothing to disclose; Dr. Milkas: nothing to disclose; Dr. Velagapudi: nothing to disclose; Dr. Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories; Dr. Rangan: nothing to disclose; Dr. Garcia: Institutional Research grants from Edwards Lifesciences and Boston Scientific; proctors Edwards Lifesciences.; Dr. Burke: shareholder in Egg Medical and MHI Ventures; Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens; owner, Hippocrates LLC; shareholder: MHI Ventures.
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Background: The optimal access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) continues to be debated. Methods: 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. Results: 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. Conclusion: 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.
AB - Background: The optimal access site for cardiac catheterization in patients with prior coronary artery bypass surgery (CABG) continues to be debated. Methods: 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. Results: 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. Conclusion: 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.
KW - catheterization brachial/radial/ulnar
KW - complications
KW - coronary bypass grafts
KW - meta-analysis
KW - percutaneous coronary intervention (PCI)
KW - vascular access
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U2 - 10.1002/ccd.30010
DO - 10.1002/ccd.30010
M3 - Article
C2 - 34779096
AN - SCOPUS:85119353115
SN - 1522-1946
VL - 99
SP - 462
EP - 471
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -