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Desai AM, Desai D, Gan A, Mehta D, Ding K, Gan F, Riangwiwat T, Sethi PS, Mukherjee A, Pai RG, Prasitlumkum N. Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:642-650. [PMID: 37409665 DOI: 10.2459/jcm.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIM Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. RESULTS The total population in our 41 pooled studies comprised 1 112 136 patients - average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized-controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48-1.06, P -value = 0.013, I2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86-1.34, P -value = 0.921, I2 = 0.0%). CONCLUSIONS There was no significant difference in stroke outcomes between the TR approach and the TF approach.
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Affiliation(s)
- Aditya M Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Darshi Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Arnold Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Devanshi Mehta
- Osteopathic Medicine, Western University of Health Sciences, Pomona
| | - Kimberly Ding
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Frances Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Tanawan Riangwiwat
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Prabhdeep S Sethi
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ashis Mukherjee
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ramdas G Pai
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Narut Prasitlumkum
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
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Muacevic A, Adler JR, Malani SK, Manade VV. Comparative Study of Transradial Versus Transfemoral Route Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction. Cureus 2022; 14:e32983. [PMID: 36712754 PMCID: PMC9877718 DOI: 10.7759/cureus.32983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Percutaneous coronary intervention (PCI) is the first choice of treatment for myocardial infarction (MI). However, entry site failure is still one of the major complications faced by the interventionist. Hence the present study compared the efficacy and complications of radial and femoral approaches in PCI in ST-elevation myocardial infarction (STEMI). Methods A hospital-based prospective study was conducted on patients with acute STEMI. A total of 100 patients were enrolled that were randomly divided into two groups of 50 each, i.e., patients that had undergone PCI by radial approach (N=50) and those who had undergone PCI by femoral approach (N=50). Results The male-to-female ratio was 1.5:1 and 1.6:1 in the transradial (TR) and transfemoral (TF) groups, respectively. With respect to age, both the groups were dominated by the age group of 50-60 years, with 42% in the TR group and 34% in the TF group having an age >60 years. The mean access time, fluoroscopy time, and procedural time in the TR group were 6.0 ± 0.7 minutes, 5.9 ± 0.6 minutes, and 29.55 ± 0.9 minutes, respectively. In the TF group, the mean access time, fluoroscopy time, and procedural time were 5.1 ± 0.5 minutes, 5.5 ± 0.7 minutes, and 26.7 ± 2.1 minutes, respectively. In the TR group, ecchymosis and loss of radial pulse were observed in 10% of the patients, thrombophlebitis in 4%, and bleeding complications in 2%. While in the TF group, ecchymosis was observed in 26%, followed by thrombophlebitis (24%), minor hematoma, and bleeding complications (14%). Conclusion The present study emphasizes the use of radial access in patients with ST-segment elevation acute coronary syndrome, as this approach was associated with significant clinical benefits. Moreover, bleeding complications were more in patients undergoing TF intervention.
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Radial Artery Access for Acute Coronary Syndromes: a Review of Current Evidence. Curr Cardiol Rep 2022; 24:383-392. [PMID: 35286661 DOI: 10.1007/s11886-022-01656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review the evidence supporting the use of transradial access (TRA) for percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). RECENT FINDINGS There have been five major randomized controlled trials (RCTs) and two recent meta-analyses comparing outcomes of TRA and femoral access (FA) in ACS. Additional studies have explored the impact of TRA on STEMI door-to-balloon (D2B) times, TRA in high-risk ACS patients, the potential conflict between TRA and coronary artery bypass graft (CABG) surgery employing the radial artery, and distal radial artery (DRA) access. TRA is associated with a reduction in net adverse clinical events, major bleeding, acute renal injury, and access site complications compared to FA in ACS patients undergoing PCI. TRA is not associated with significant delays in STEMI D2B times that impact patient outcomes. Further studies are needed to evaluate the role of TRA in high-risk ACS patients, the interplay between TRA and radial artery CABG, and use of DRA in ACS.
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Sattar Y, Majmundar M, Ullah W, Mamtani S, Kumar A, Robinson S, Zghouzi M, Mir T, Dhamrah U, Al-Khadra Y, Pacha HM, Darmoch F, Soud M, Hakim Z, Bagur R, Kaul P, Ijioma N, Panchal A, Shroff AR, Alraies MC. Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:433-444. [PMID: 33896335 DOI: 10.1080/14779072.2021.1915768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial. METHODS PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model. RESULTS We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year. CONCLUSION TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Monil Majmundar
- New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sahil Mamtani
- Internal Medicine, Atlantic Care Regional Medical Center, Atlantic City, NJ, USA
| | - Ashish Kumar
- Internal Medicine, St John's Medical College Hospital, Bangalore, India
| | - Sam Robinson
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Umaima Dhamrah
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Yasser Al-Khadra
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Homam Moussa Pacha
- McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Heart & Vascular Institute, Houston, TX, USA
| | - Fahed Darmoch
- Internal Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Zaher Hakim
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Rodrigo Bagur
- London Health Science Centre, Western University, London, Canada
| | - Prashant Kaul
- Department of Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Ankur Panchal
- Department of Cardiology, University of Pittsburgh Medical Center, PA, USA
| | - Adhir R Shroff
- Department of Cardiology, University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, IL, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Chang K, Ahn Y, Lim S, Yang JH, Lee KY, Choo EH, Kim HK, Nam CW, Kim W, Hwang JY, Rha SW, Kim HS, Cho MC, Jang Y, Jeong MH. 2021 Korean Society of Myocardial Infarction Expert Consensus Document on Revascularization for Acute Myocardial Infarction. Korean Circ J 2021; 51:289-307. [PMID: 33821579 PMCID: PMC8022023 DOI: 10.4070/kcj.2021.0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 01/30/2023] Open
Abstract
Acute myocardial infarction (AMI) is a fatal manifestation of ischemic heart disease and remains a major public health concern worldwide despite advances in its diagnosis and management. The characteristics of patients with AMI, as well as its disease patterns, have gradually changed over time in Korea, and the outcomes of revascularization have improved dramatically. Several characteristics associated with the revascularization of Korean patients differ from those of patients in other countries. The sophisticated state of AMI revascularization in Korea has led to the need for a Korean expert consensus. The Task Force on Expert Consensus Document of the Korean Society of Myocardial Infarction has comprehensively reviewed the outcomes of large clinical trials and current practical guidelines, as well as studies on Korean patients with AMI. Based on these comprehensive reviews, the members of the task force summarize the major guidelines and recent publications, and propose an expert consensus for revascularization in patients with AMI.
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Affiliation(s)
- Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Woon Rha
- Divison of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyo Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yangsoo Jang
- Divison of Cardiology, Department of Internal Medicine, Severance Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea.
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Poudel I, Tejpal C, Rashid H, Jahan N. Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review. Cureus 2019; 11:e5280. [PMID: 31423405 PMCID: PMC6695291 DOI: 10.7759/cureus.5280] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Major adverse cardiovascular events (MACE) remain the major cause of mortality and morbidity in patients with STEMI (ST-elevation myocardial infarction). The current literature is aimed to analyze the occurrence of MACE following STEMI irrespective of treatment provided, and follow up after the first diagnosis of STEMI. A PubMed search for Studies of STEMI identified 24,244 articles. After applying our inclusion/exclusion criteria, we found out 75 articles of relevance wherein MACE and its components were considered to be the primary endpoint. These 75 articles included eight Cohort Studies, 13 clinical trials including five randomized controlled trials (RCT), one case-control Study, one cross-sectional study, one review article, and 51 other observational studies. Our analysis shows that MACE remains one of the strongest adverse outcomes among STEMI patients. The current literature review found out the incidence of MACE was 4.2 % to 51% irrespective of the mode of treatment, and follow-ups lasting up to 10 years from the time of STEMI diagnosis.
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Affiliation(s)
- Ishan Poudel
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Chavi Tejpal
- Family Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hamza Rashid
- Internal Medicine: Critical Care, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Lee BK. Transradial intervention as the first choice of treatment for ST elevation myocardial infarction patients: editorial comment. Korean J Intern Med 2018; 33:691-692. [PMID: 29961310 PMCID: PMC6030421 DOI: 10.3904/kjim.2018.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Byoung Kwon Lee, M.D. Department of Internal Medicine, Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea Tel: +82-2-2019-3307 Fax: +82-2-3463-3882 E-mail:
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