What does this research mean for the field?

Procedure time for emergent percutaneous coronary intervention in STEMI patients is generally comparable between radial and femoral access, though the lack of a standardized definition for procedure time across studies leads to divergent results. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2018Heart ViewsOpen Access

Procedure time comparison between radial versus femoral access in ST-segment elevation acute myocardial infarction patients undergoing emergent percutaneous coronary intervention: A Meta-analysis of controlled randomized trials

View Full Paper

Ask AI

Bookmark

Why the study?

Does radial access improve or reduce procedure time compared to femoral access in STEMI patients undergoing emergent PCI?

Structured PICO

Does radial access improve or reduce procedure time compared to femoral access in STEMI patients undergoing emergent PCI?

Population

4,173 patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergent percutaneous coronary intervention (PCI) pooled from 12 controlled randomized trials (2,052 in radial group and 2,121 in femoral group).

Intervention

Radial access for emergent percutaneous coronary intervention (PCI)

Comparator

Femoral access for emergent percutaneous coronary intervention (PCI)

Outcome

Procedure time (mean difference in minutes)

Radial access for emergent PCI in STEMI patients does not significantly increase procedure time compared to femoral access, supporting its routine use without concern for clinically meaningful delays.

Limitations

Absence of a common definition for procedure time between different studies
Difference in sample size between trials
Results could not be extrapolated to the subgroup of patients with cardiogenic shock

Implication

Radial access adds no meaningful procedure time in emergent STEMI PCI; confirms comparability to femoral and supports radial-first strategy.

Abstract

Introduction: There are inconclusive data about the potential delay of procedure time in emergent percutaneous coronary intervention (PCI) by radial compared with femoral approach in patients with ST-segment elevation myocardial infarction (STEMI).Aims: The purpose of the current study is to conduct a comprehensive meta-analysis of controlled randomized trials (CRTs) comparing the procedure time in STEMI patients undergoing emergent PCI with radial versus femoral access.Methods: Formal search of CRTs through electronic databases (Medline and PubMed) was performed from January 1990 to October 2014 without language restrictions. Mean difference (MD) of procedure time was evaluated as overall effect.Results: Twelve studies were included with 2052 and 2121 patients in radial and femoral group, respectively. Variability in the definition of procedure time was found with unavailability of a precise definition in 41.6% of studies. When all studies were included, no significant longer procedure time in radial approach was detected (MD [95% confidence interval [CI] = 1.6 min [−0.10, 3.3], P = 0.07, P het = 0.56). After deleting RIVAL trial, procedure time was significantly longer in radial group (MD [95% CI] = 1.5 min [0.71, 2.3], P < 0.001, P het = 0.20). Meta-analysis of three studies with similar definition of procedure time showed (MD [95% CI] = 1.26 min [−0.43, 2.95], P = 0.14, P het = 0.85).Conclusions: Although the procedure time in STEMI patients undergoing emergent PCI by radial access is generally comparable with femoral approach, there is an absence of uniformity in its definition, which leads to divergent results. A standardized definition of procedure time is required to elucidate this relevant matter.