Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis
Department
Internal Medicine
Document Type
Article
Publication Title
The American Journal of Cardiology
Abstract
Transradial access (TRA) and transulnar access (TUA) are in close vicinity, but TRA is the preferred intervention route. The cardiovascular outcomes and access site complications of TUA and TRA are understudied. Databases, including MEDLINE and Cochrane Central registry, were queried to find studies comparing safety outcomes of both procedures. The outcome of interest was in-hospital mortality and access site bleeding. Secondary outcomes were all-cause major adverse cardiovascular events, crossover rate, artery spasm, access site large hematoma, and access site complications between TUA and TRA. A random-effect model was used with regression to report unadjusted odds ratios (ORs) by limiting confounders and effect modifiers, using software STATA V.17. A total of 4,796 patients in 8 studies were included in our analysis (TUA = 2,420 [50.4%] and TRA = 2,376 [49.6%]). The average age was 61.3 and 60.1 years and the patients predominantly male (69.2% vs 68.4%) for TUA and TRA, respectively. TUA had lower rates of local access site bleeding (OR 0.58, 95% confidence interval 0.34 to 0.97, I2 = 1.89%, p = 0.04) but higher crossover rate (OR 1.80, 95% confidence interval 1.04 to 3.11, I2 = 75.37%, p = 0.04) than did TRA. There was no difference in in-hospital mortality, all-cause major adverse cardiovascular events, arterial spasm, and large hematoma between both cohorts. Furthermore, there was no difference in procedural time, fluoroscopy time, and contrast volume used between TUA and TRA. TUA is a safer approach, associated with lower access site bleeding but higher crossover rates, than TRA. Further prospective studies are needed to evaluate the safety and long-term outcomes of both procedures.
First Page
92
Last Page
100
DOI
10.1016/j.amjcard.2023.05.070
Volume
201
Publication Date
8-15-2023
Medical Subject Headings
Humans; Male; Female; Treatment Outcome; Ulnar Artery; Radial Artery; Coronary Angiography (methods); Hemorrhage (etiology); Hematoma (epidemiology, etiology); Percutaneous Coronary Intervention (methods); Cardiovascular Diseases (etiology); Spasm (complications); Femoral Artery; Catheterization, Peripheral (adverse effects, methods)
PubMed ID
37352671
Recommended Citation
Faisaluddin, M., Sattar, Y., Song, D., Titus, A., Erdem, S., Alsaud, A., Alharbi, A. A., Sulaiman, S., Khan, S. U., Elgendy, I. Y., Sengodan, P., Dani, S. S., Alam, M., Alraies, M. C., & Daggubati, R. (2023). Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis. The American Journal of Cardiology, 201, 92-100. https://doi.org/10.1016/j.amjcard.2023.05.070