Transradial versus transfemoral percutaneous coronary intervention in elderly patients: a systematic overview and meta-analysis

Background Transradial approach (TRA) percutaneous coronary intervention (PCI) has been wildly applied among unselected patients. However, only very few small studies have compared the outcomes between TRA and transfemoral approach (TFA) in elderly patients. We aimed to evaluate the efficacy and safety between TRA and TFA in elderly patients by a pooled analysis. Methods Studies that met the inclusion and exclusion criteria were included. Statistical analysis was performed using the Review Manager 5.0.0 developed and maintained by the Cochrane Collaboration and a random-effects model was used to better account for the differences among the sub-studies. The primary endpoint was defined as short-term mortality, and other endpoints included major adverse cardiovascular events, major bleeding events, procedure success, vascular complications and hospital stay. Results Two thousand one hundred and eighty-eight patients from 11 studies were finally included. A non-significant trend toward a lower rate of short-term death was found in favor of TRA (odds ratio (OR): 0.56, 95% confidence interval (CI): 0.27-1.16). The incidence rates of vascular complications (OR 0.25, 95% CI: 0.14-0.46) and major bleeding events (OR: 0.31, 95% CI: 0.18-0.55) were greatly reduced by TRA compared with TFA. No significant difference was detected in the occurrence rate of major adverse cardiovascular events (OR: 0.77, 95% CI: 0.45-1.30), but the rate of procedure success was significantly improved by TRA (OR: 1.86, 95% CI: 1.18-2.94). In addition, the total hospital stay was also significantly reduced by TRA. Conclusions TRA showed greater efficacy and safety compared with TFA in elderly patients. It should be recommend as routine practice for elderly patients undergoing PCI in TRA capable hospitals.