Clinical Effctiveness And Safety Of Primary Percutaneous Interventions Via Radial Access For Patients With Acute ST-Segment Elevation Myocardial Infarction:a Meta-Analysis

Objective:To systematically evaluate the efficacy and safety of radial access compared with femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).Methods:Randomized controlled trials (RCT) about the clinical effectiveness and safety of radial access for PCI in patients with STEMI was searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 6,2014), CNKI, VIP and WanFang Data from the date of their establishment to November 2014, and other relevant journals and references of the included literature were also searched manually. The screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then meta-analysis was conducted using RevMan 5.2 software.Results:A total of fourteen RCT including 5 212 patients were enrolled. In all trials,the results indicated that:a) radial approach was associated with decreased risk of mortality (OR=0.54,95%CI 0.40 to 0.74,P=0.000 1), reduce the risk of major bleeding (OR=0.50, 95%CI 0.34 to 0.74, P=0.000 8), and decrease the risk of major adverse cardiac events (MACE) (OR=0.65,95%CI 0.50 to 0.83, P=0.0006), and decrease the risk of access site complications (OR=0.35,95%CI 0.25 to 0.49, P<0.00001), and decrease the time of the hospitalization time (MD=-2.14,95%CI -3.97 to -0.31, P=0.002); and b) the achievement ratio of interventional surgery, exposure time of X ray, stroke risk, CABG risk, myocardial infarction risk without significant differences compared with the control group. Conclusion:In STEMI patients undergoing primary PCI, the radial approach is associated with favorable outcomes and should be the preferred approach for experienced radial operators and fit strict indications. The lower risk of mortality, major bleeding, MACE, specially access site complications through make the radial approach superior to the femoral approach. In addition, due to the low methodological quality of studies included, larger sample, high quality randomized controlled trials are necessary.