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- cardiac catheterization and angiography
- cardiac procedures and therapy
- interventional cardiology and endovascular procedures
- percutaneous coronary intervention
- coronary artery disease
Coronary heart disease is the most common cause of morbidity and mortality worldwide.1 Coronary artery disease (CAD) is a term referring to partial or complete blockage in blood supply to the heart. In a certain subset of patients with CAD, such as those with the acute coronary syndrome (ACS) and symptomatic patients despite optimal medical therapy, revascularisation of the blocked arteries is often indicated.2 Historically, coronary artery bypass grafting (CABG) has been the mainstay of revascularisation therapy. The advent of percutaneous coronary intervention (PCI) since the late 1990s, particularly with the development of drug-eluting stents, has increasingly challenged the role of CABG, with a growing momentum towards less invasive approaches.3 The gold standard for visualising coronary anatomy is diagnostic coronary angiography (CA) with an ultimate goal of intervention on the blocked or stenosed segment to restore blood flow to the ischaemic heart muscle. Access is achieved percutaneously via different approaches, most commonly the femoral artery and more recently, the radial artery. Each approach has its own inherent advantages and disadvantages, relating to the access site and technique as well as operator experience and learning curve.2 The objective of our Cochrane review was to compare the safety and effectiveness of both approaches in patients undergoing diagnostic CA and PCI across the whole spectrum of CAD.4
We searched for randomised controlled trials (RCTs) comparing the transradial and transfemoral approaches in adult patients (≥18 years old), of all genders, undergoing diagnostic CA and/or PCI for CAD in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Web of Science Core Collection since their inception up to October 2017. We also searched WHO International Clinical Trials Registry Platform and ClinicalTrials.gov up to August 2017 for ongoing clinical trials.4 Cochrane standards were maintained and the Grading of Recommendations, Assessment, …
Contributors AAK: Screening titles, abstracts, and full texts for eligibility; data extraction from the included studies; assessment of risk of bias; data entry in data and analyses tables; conducting meta-analyses; interpreting results; drafting the manuscript; revising the final draft. RSA: Screening titles, abstracts, and full texts for eligibility; data extraction from the included studies; assessment of risk of bias; revising the final draft. AMM: Data entry in data and analyses tables; conducting meta-analyses; interpreting results; drafting the results, discussion, abstract, and plain language summary sections; revising the final draft. MEZ: Providing clinical content expertise and revising the final draft. MAE-W: Data extraction from the included studies; assessment of risk of bias; data entry in the tables of included studies; data entry in data and analyses tables; creating GRADE ‘Summary of findings’ table; revising the final draft. AFN: Performing hand searches and searching reference lists; revising the assessment of risk of bias and resolving disagreements; conducting meta-analyses; creating GRADE ‘Summary of findings’ table; interpreting results; revising the final draft. All authors approved the final draft of the full review. AAK and AFN are guarantors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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