Systematic Review Of Perspective Study In China About Radial Versus Femoral Approach For Coronary Angiography And Percutaneous Coronary Intervention

Background Overseas evidence based medicine researches about comparison of different approaches for percutaneous coronary diagnostic and interventional procedures have been finished, which confirmed that the radial approach can guarantee high success rate and reduce local vascular complications compared with the femoral approach. However, the inner diameter of Chinese radial arteries is small, so it is quite necessary to make sure that if the radial approach is also suit for Chinese people for coronary angiography and percutaneous coronary intervention.Objective To systematically review the feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) through the radial approach in China.Methods The papers from 1989 to 2008 were retrieved from biomedicine bibliographic database of China (CBM), MEDLINE, EMBASE, and Cochrane, which were about randomized controlled trials (RCT) and non-randomized controlled trials to compare the radial approach with the femoral approach. Software of Revman4.2.3 was used to carry out Meta-analysis after the quality of the papers was evaluated.Results In this field, RCT of China was not found, and 9 perspective controlled trials (n=2389) were included. (l)Meta-analysis of 3 trials (n=1013) showed that the success rate of CAG was similar for the radial versus femoral approach [RR=0.98, 95%CI(0.95, 1.00)]. (2)Meta-analysis of 6 trials (n=1441) showed that the success rate of PCI was similar for the radial versus femoral approach [RR=0.99, 95%CI (0.97, 1.01)]. (3)None of the major adverse cardiovascular events (MACE) was found in 4 trials. In one trial, 3 cases of transradial intervention (TRI) group and 2 cases of transfemoral intervention (TFI) group died of acute coronary obstruction. The other trials did not carry out research of this part. (4)Meta-analysis of 8 trials (n=2236) showed that the radial approach had a higher proportion of intubation failures than that of the transfemoral approach [RR=1.59, 95%CI (1.02, 2.47)]. (5)Meta-analysis of 9 trials (n=2389) showed that the rate of local vascular complications of TRI group was lowered than that of the TFI group [RR=0.50, 95%CI (0.29, 0.86)]. (6)Meta-analysis of 5 trials (n=1293) showed that the length of stay of TRI group was shorter than that of TFI group[WMD=-2.68, 95%CI (-3.55, -1.81)].(7) The doses of contrast agent, exposure time of X ray, time for arteriopuncture, time for PCI showed no significant differences between the TRI group and the TFI group.Conclusions In Chinese, the radial approach for coronary procedures appears as a safe alternative to femoral access. The lower rate of local vascular complications, especially hemorrhagic complications, the shorter time of lying in bed and staying in hospital through make the radial approach superior to the femoral approach. But it is more difficult to carry out PCI through radial approach. Moreover, it is necessary to improve the operability of equipment and supplies for radial approach and reduce the rate of arteriospasm and obstruction of radial artery.