Influence of access site choice for cardiac catheterization on risk of adverse neurological events: A systematic review and meta-analysis

Sirker, A., Kwok, C. S., Kotronias, R., Bagur, R., Bertrand, O., Butler, R., Berry, C. , Nolan, J., Oldroyd, K. and Mamas, M. (2016) Influence of access site choice for cardiac catheterization on risk of adverse neurological events: A systematic review and meta-analysis. American Heart Journal, 181, pp. 107-119. (doi:10.1016/j.ahj.2016.06.027) (PMID:27823682)

Full text not currently available from Enlighten.

Abstract

Background: Stroke is a rare but potentially catastrophic complication of cardiac catheterization. Although some procedural aspects are known to influence stroke risk, the impact of radial versus femoral access site use is unclear. Early observational studies and limited randomized trial data suggested more frequent embolic events with radial access. Subsequently, larger pooled analyses have shown no clear differences in stroke risk but were limited by low event rates. Recent publication of relevant new data prompted our reevaluation of this concern. Therefore, we conducted a systematic review and meta-analysis to evaluate stroke complicating cardiac catheterization with use of transradial versus transfemoral access. Methods and results: A search of MEDLINE and EMBASE was undertaken using OVID SP with appropriate search terms. RevMan 5.3.5 was used to conduct a random-effects meta-analysis using the inverse variance method for pooling risk ratios (RRs) or the Mantel-Haenszel method for pooling dichotomous data. Pooled data from N24,000 patients in randomized controlled trials and N475,000 patients from observational studies were used. The risk ratio (RR) for (any) stroke, using randomized controlled trial data, was not significant (RR 0.87, 95% CI 0.58-1.29). Using observational data, a significant difference favoring radial access was seen (RR 0.71, 95% CI 0.52-0.98). Conclusions: Radial access site utilization for cardiac catheterization is not associated with an increased risk of stroke events. These data provide reassurance and should remove another potential barrier to conversion to a “default” radial practice among those who are currently predominantly femoral operators.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Oldroyd, Dr Keith and Berry, Professor Colin
Authors: Sirker, A., Kwok, C. S., Kotronias, R., Bagur, R., Bertrand, O., Butler, R., Berry, C., Nolan, J., Oldroyd, K., and Mamas, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:American Heart Journal
Publisher:Elsevier
ISSN:0002-8703
ISSN (Online):1097-6744
Published Online:28 August 2016

University Staff: Request a correction | Enlighten Editors: Update this record