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Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients.

Xia SL, Zhang XB, Zhou JS, Gao X - Braz. J. Med. Biol. Res. (2015)

Bottom Line: There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38).A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02).We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

View Article: PubMed Central - PubMed

Affiliation: Affiliated Nanjing Jiangbei People's Hospital, Department of Cardiology, Southeast University, Nanjing, Jiangsu, China.

ABSTRACT
The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of secondary outcomes. A, Comparison of theleft radial approach (LRA) versus the right radial approach (RRA) for contrastvolume. B, Comparison of the LRA versus the RRA for proceduraltime. In the study of Sciahbasi (13), wereported the meta-analysis results of percutaneous coronary intervention (PCI) anddiagnostic angiography (Angio). See Table1 for numbers of all references cited.
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f03: Meta-analysis of secondary outcomes. A, Comparison of theleft radial approach (LRA) versus the right radial approach (RRA) for contrastvolume. B, Comparison of the LRA versus the RRA for proceduraltime. In the study of Sciahbasi (13), wereported the meta-analysis results of percutaneous coronary intervention (PCI) anddiagnostic angiography (Angio). See Table1 for numbers of all references cited.

Mentions: The secondary outcome of contrast volume showed a significant benefit for the LRA overthe RRA in the study participants (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009; Figure 3A). There was no significant differencebetween the two approaches in the duration of the procedure (SMD=-0.05, 95%CI=-0.17 to0.06; P=0.38; Figure 3B). However, a significant,moderate heterogeneity was found among the studies reporting the duration of procedures(P<0.00001; I2=77%).


Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients.

Xia SL, Zhang XB, Zhou JS, Gao X - Braz. J. Med. Biol. Res. (2015)

Meta-analysis of secondary outcomes. A, Comparison of theleft radial approach (LRA) versus the right radial approach (RRA) for contrastvolume. B, Comparison of the LRA versus the RRA for proceduraltime. In the study of Sciahbasi (13), wereported the meta-analysis results of percutaneous coronary intervention (PCI) anddiagnostic angiography (Angio). See Table1 for numbers of all references cited.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541695&req=5

f03: Meta-analysis of secondary outcomes. A, Comparison of theleft radial approach (LRA) versus the right radial approach (RRA) for contrastvolume. B, Comparison of the LRA versus the RRA for proceduraltime. In the study of Sciahbasi (13), wereported the meta-analysis results of percutaneous coronary intervention (PCI) anddiagnostic angiography (Angio). See Table1 for numbers of all references cited.
Mentions: The secondary outcome of contrast volume showed a significant benefit for the LRA overthe RRA in the study participants (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009; Figure 3A). There was no significant differencebetween the two approaches in the duration of the procedure (SMD=-0.05, 95%CI=-0.17 to0.06; P=0.38; Figure 3B). However, a significant,moderate heterogeneity was found among the studies reporting the duration of procedures(P<0.00001; I2=77%).

Bottom Line: There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38).A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02).We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

View Article: PubMed Central - PubMed

Affiliation: Affiliated Nanjing Jiangbei People's Hospital, Department of Cardiology, Southeast University, Nanjing, Jiangsu, China.

ABSTRACT
The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

No MeSH data available.


Related in: MedlinePlus