PT  - JOURNAL ARTICLE
AU  - Mamas A Mamas
AU  - Karim Ratib
AU  - Helen Routledge
AU  - Farzin Fath-Ordoubadi
AU  - Ludwig Neyses
AU  - Yves Louvard
AU  - Douglas G Fraser
AU  - Jim Nolan
TI  - Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials
AID  - 10.1136/heartjnl-2011-300558
DP  - 2012 Feb 15
TA  - Heart
PG  - 303--311
VI  - 98
IP  - 4
4099  - http://heart.bmj.com/content/98/4/303.short
4100  - http://heart.bmj.com/content/98/4/303.full
SO  - Heart2012 Feb 15; 98
AB  - Objective A meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI).Design A Medline and Embase search was conducted using the search terms ‘transradial,’ ‘radial’, ‘STEMI’, ‘myocardial’ and ‘infarction’.Setting Randomised controlled studies that compare outcomes of transradial versus the transfemoral route.Patients A total of nine studies were identified that consisted of 2977 patients with STEMI.Interventions Studies that compare outcomes of transradial versus the transfemoral route.Main outcome measures The primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications.Results Transradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p=0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p=0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route.Conclusions This meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.