Abstract 14294: Comparison of Procedural Outcomes in Patients Undergoing Right Versus Left Trans-Radial Percutaneous Coronary Procedures: A Meta-Analysis of Randomized Clinical Trials
Background: Majority of the transradial procedures are performed by using right radial approach (RRA). The left radial approach (LRA) has anatomical advantage of being direct access to the ascending aorta. Clinical trials comparing RRA and LRA have yielded mixed results. Hence, we performed meta-analysis to evaluate the safety and efficacy of LRA compared with RRA for diagnostic coronary angiogram (CA) and percuatneous coronary interventional (PCI) procedures.
Methods: A systemic literature search identified 8 prospective randomized clinical trials including 8050 patients. End points extracted were fluoroscopy time, time to CA, time to PCI, procedure time, contrast amount, procedural success, cross over to femoral approach, local complications, subclavian tortuosity and procedure related stroke. Combined odds ratios (OR) across all the studies and 95% confidence intervals (CI) were computed. A two-sided alpha error <0.05 was considered to be statistically significant.
Results: Compared to patients with LRA, those with RRA were at significantly high incidence of subclavian toruosity (RR: 2.285, CI: 1.711-3.050, p<0.001) but other hand fluoroscopy time(RR: 1.279, CI: 0.924-1.771, p=0.138), time to CA(RR: 1.095, CI: 0.820-1.463, p=0.537), time to PCI(RR: 1.108, CI: 0.958-1.281, p=0.166), procedure time(RR: 1.245, CI: 0.818-1.896, p=0.306), contrast amount (RR: 1.108, CI: 0.939-1.308 p=0.226), procedural success(RR: 1.138, CI: 0.685-1.896, p=0.617) and cross over to femoral approach(RR: 1.361, CI: 0.582-3.180, p=0.477),did not differ between the two groups. Both groups had similar rates for local complication (RR: 0.208, CI: 0.042-1.019, p=0.053) and procedure related strokes (RR: 2.542, CI: 0.469-13.787, p=0.280).
Conclusion: Both LRA and RRA are similar in efficacy and safety analysis.
- © 2011 by American Heart Association, Inc.