Effects of distal radial access vs conventional radial access in patients undergoing coronary angiography and/or intervention: a meta-analysis of randomised trials
Notice bibliographique
Résumé
Abstract Background Recently the distal radial access (DRA) technique has been introduced for coronary angiography and intervention as an alternative to the conventional radial access (RA). Purpose The aim of this study was to provide a quantitative appraisal of the effects of DRA vs conventional RA for coronary angiography with or without intervention. Methods The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomised clinical trials (RCT) comparing DRA versus RA for coronary angiography and/or intervention. Data were pooled by meta-analysis using a random-effects model. The number of patients needed to treat for an additional beneficial outcome (NNTB) and the number needed to treat for an additional harmful outcome (NNTH) were calculated. The primary endpoint was radial artery occlusion (RAO) at the longest available follow-up. Additional secondary outcomes were assessed. Results A total of 13 RCT including 4,901 patients were identified and included in the final analysis. Coronary angiography alone was performed in 3 studies, percutaneous coronary intervention was performed in a variable proportion of patients ranging from 24% to 100% across studies. Study population included patients with chronic coronary syndrome in the large majority, and the proportion of acute coronary syndrome ranged from to 31% to 100% across studies. Compared with RA, DRA was associated with a significant lower risk of RAO, either detected at the longest follow-up (risk ratio [RR]: 0.36; 95% CI: 0.23 to 0.58; p<0.001, NNTB = 24.5), or in-hospital (RR: 0.32; 95% CI: 0.18 to 0.57; p<0.001, NNTB = 21.5), as well as Early discharge after transradial stenting of coronary arteries (EASY) Scale ≥ II hematoma (RR: 0.46; 95% CI: 0.22 to 0.97; p=0.04, NNTB = 66). By contrast, DRA was associated with a higher risk of access site crossover (RR: 3.43; 95% CI: 1.88 to 6.25, p<0.001, NNTH = 10), a longer time for radial artery puncture (standardized mean difference [SMD]: 3.56; 95% CI: 0.96 to 6.16; p<0.001), and sheath insertion (SMD: 0.38; 95% CI: 0.11 to 0.65, p=0.006), and a higher number of puncture attempts (SMD: 0.59, 95% CI: 0.48 to 0.69, p<0.001). A meta-regression analysis showed that increasing age in the RA group was associated with a reduced effect of DRA, compared with RA, on the risk of RAO. No significant effect of other variables such as the prevalence of female sex, diabetes, smoking status, acute coronary syndrome, and percutaneous coronary intervention was found. Conclusions Compared with RA, DRA is associated with lower risks of RAO and EASY ≥ II hematoma, but requires longer time for radial artery puncture and sheath insertion, more puncture attempts and a higher access site crossover. Funding Acknowledgement Type of funding sources: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».