Data comparing outcomes of transradial (TR) versus transfemoral (TF) access for percutaneous
coronary intervention (PCI) in chronic kidney disease (CKD) including patients with
eGFR< 30 ml/min/1.73m2 and patients with end-stage renal disease on dialysis (ESRD) are lacking. This meta-analysis
compares the outcomes of TR versus TF approach for PCI in patients with CKD. PubMed,
Embase, Cochrane, ClinicalTrials.gov, and Google Scholar were searched for studies
including adults with CKD undergoing PCI via a TR versus TF approach from January
1, 2000, until January 15, 2021. The primary outcome was in-hospital all-cause mortality
and secondary outcomes included major bleeding, stroke, myocardial infarction (MI),
blood transfusion, contrast volume, and fluoroscopy time. The analysis was performed
using a random-effects-model using the Mantel‐Haenszel method. Five observational
studies met inclusion criteria, including 1,156 and 6,156 patients in the TR and TF
arms, respectively. The mean age of included patients was 70.5 years, 66% were male
and 90% had ESRD. In patients with CKD, TR access for PCI was associated with lower
all-cause mortality (RR = 0.48; 95% CI: 0.32 to 0.73), major bleeding (RR = 0.51;
95% CI: 0.36 to 0.73), blood transfusion (RR = 0.53, 95% CI: 0.42 to 0.68) and contrast
volume (SMD -0.34 [-0.60 to -0.08]) with no difference in stroke, MI, or fluoroscopy
time compared with TF access. In conclusion, in patients with CKD undergoing PCI,
the TR approach was associated with a lower risk of in-hospital mortality, post-procedural
bleeding, and blood transfusion compared with TF access.
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Article Info
Publication History
Published online: August 11, 2021
Received in revised form:
July 2,
2021
Received:
May 24,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
