Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis

Authors

• Mohammed Faisaluddin, Rochester Regional HealthFollow
• Yasar Sattar, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
• David Song, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, New York, New York.
• Anoop Titus, Saint Vincent Hospital, Worcester, Massachusetts.
• Saliha Erdem, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
• Ali Alsaud, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
• Anas A. Alharbi, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
• Samian Sulaiman, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
• Safi U. Khan, Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas.
• Islam Y. Elgendy, Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
• Prasanna Sengodan, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
• Sourbha S. Dani, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts.
• Mahboob Alam, Department of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas.
• M Chadi Alraies, Cardiovascular Institute, Detroit Medical Center, DMC Heart Hospital, Detroit, Michigan.
• Ramesh Daggubati, Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.

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