Table 1

Summary of the studies included in meta-analysis

Studies (year)NumberSingle centre/multi centreExclusion criteriaSTEMI cohortAnticoagulant/antiplatelet protocolOperator radial experience for participation in study
TEMPURA (2003)149Single centreThrombolysis, cardiogenic shock with weak radial pulse, abnormal Allen's test, occluded SVG grafts, culprit artery considered not suitable for PCI because of extreme tortuosity and/or calcification proximally or vessel size <2.5 mm in diameter by visual estimatePrimary PCI 100%5000/6000 units of heparin given for female/male patients, respectively. Oral administration of aspirin of 162 mg or more and ticlopidine of 200 mg daily were started as soon as possible after stent implantation and continued for more than 4 weeksNot available
RADIAL-AMI (2005)50MulticentreCardiogenic shock, abnormal Allen's test result, or contraindication to GP IIb/IIIa inhibitorPrimary PCI 34%Rescue PCI 66%Heparin (target activated clotting time, 200–300 s), aspirin (325 mg before the procedure) and clopidogrel (300 mg loading dose, 75 mg daily for a minimum of 28 days after the procedure). Abciximab (a bolus of 0.25 mg/kg before or during procedure followed by an infusion of 0.125 microg/kg/min (maximum of 10 μg/min)) for 12 h after PCIRequired to have performed minimum of 100 transradial PCI procedures before study
FARMI (2007)114Single centreHistory of CABG, cardiogenic shock, atrioventricular block and contraindication to abciximab or an abnormal Allen's test
  • Primary PCI 50.9%

  • Rescue PCI 42.1%

  • Facilitated PCI 7%

IV bolus heparin (unfractionated heparin 50 IU/kg or low molecular weight heparin (enoxaparin) 30 mg IV and 1 mg/kg subcutaneously) and a bolus of aspirin (250 mg IV). During PCI abciximab given (0.25 mg/kg bolus followed by 0.125 micrograms/kg/min infusion during 12 h). Clopidogrel (300 mg), followed by 75 mg daily for 1 year, plus 75–300 mg/day oral aspirinRequired to have undertaken more than 100 previous successful transradial coronary procedures
Yan et al (2008)103Single centreCardiogenic shock, non-palpable radial artery, abnormal Allen's test and chronic renal failurePrimary PCI 100%All patients loaded with clopidogrel 600 mg and aspirin 300 mg after the diagnosis of AMI established. Tirofiban administered with 10 μg/kg bolus IV for 3 min followed by 0.15micrograms/kg/min infusion for 24 h. During PCI, patients received a bolus of heparin (70 U/kg) then received another 2000–5000 U heparin every hour during the procedure. After PCI, patients given clopidogrel 75 mg/day for 1 year, aspirin 100–200 mg/ day for life and subcutaneous fragmin 5000 U twice daily for at least 5–7 daysNo formal entry requirements but the operators were interventional cardiologists who had performed over 500 cases of transradial PCI
RADIAMI (2009)100Single centreAge >75 years, Killip class III or IV, intra-aortic balloon pump placement before the angiogram, height <150 cm, history of CABG, if the infarction may be due to occluded bypass graftPrimary PCI 100%All patients received heparin (70 U/kg), and GP IIb/IIIa receptor blockers were administered during the PCI. Heparin administration was continued after the intervention only in the presence of clinical indicationsNo formal entry requirements but operators performed at least 50–100 transradial PCI cases previously
Gan et al (2009)195MulticentreAbnormal Allen's testPrimary PCI 100%All patients loaded with 300 mg aspirin and 300 mg clopidogrel as soon as they were diagnosed as having an AMI. Heparin administered at 100 IU/kg. GP IIb/IIIa inhibitors were administered according to the operator's discretionNot available
Hou et al (2010)200Single centreCardiogenic shock, history of coronary bypass graft, Abnormal Allen's test and non-palpable radial arteryPrimary PCI 100%All patients received aspirin (300 mg) and clopidogrel (300 mg) once diagnosis of AMI was made. Fragmin 5000 U s/c was used and GP IIb/IIIa inhibitors were administered according to the operator's discretionAt least 200 transradial PCI cases previously
RIVAL (2011)1958MulticentreCardiogenic shock, severe peripheral vascular disease precluding a femoral approach, or previous coronary bypass surgery with use of more than one internal mammary artery
  • Primary PCI 74%

  • Rescue PCI 12%

  • Facilitated PCI 3%

  • Other 11%

Antithrombotic regimen (including GP IIb/IIIa inhibitors) used for PCI was at the discretion of the treating doctorAt least 50 radial procedures for coronary angiography or PCI within the previous year
RADIAMI II (2011)108Single centreKillip class III or IV, use of an intra-aortic balloon pump or temporary right ventricular pacing, patient's height <150 cm, history of CABG, age >75 yearsPrimary PCIHeparin was used in all cases and administered in doses to achieve ACT of 350–450 s during procedures performed without the use of abciximab and 250–350 s when abciximab was used. Use of abciximab was at the operator's discretionNo formal entry requirements but senior operators with 17–20 years of experience in performing PCI via TFA and several years' experience in performing PCI via TRA, took part in the study
  • ACT, activated clotting time; AMI, acute myocardial infarction; CABG, coronary artery bypass grafting; GP, glycoprotein; STEMI, ST elevation myocardial infarction; SVG, saphenous vein grafts; TFA, transfemoral approach; TRA, transradial approach.