Short-term risk of periprocedural stroke relative to radial vs. femoral access: systematic review, meta-analysis, study sequential analysis and meta-regression of 2,188,047 real-world cardiac catheterizations
Jazyk angličtina Země Velká Británie, Anglie Médium print-electronic
Typ dokumentu systematický přehled, metaanalýza, časopisecké články
- Klíčová slova
- Stroke, accession site, catheterization, cohort, femoral, incidence, meta-analysis, meta-regression, observational, radial, real-world, trial sequential analysis,
- MeSH
- arteria femoralis MeSH
- arteria radialis MeSH
- cévní mozková příhoda * epidemiologie etiologie prevence a kontrola MeSH
- koronární angioplastika * metody MeSH
- lidé MeSH
- periferní katetrizace * metody MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- srdeční katetrizace škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
OBJECTIVES: To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS: We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS: The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION: Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.
Biomedical informatics 1st Medical Faculty Charles University Prague Czech Republic
Department of Cardiology Hospital of Pardubice Pardubice Czech Republic
Faculty of Health Studies University of Pardubice Pardubice Czech Republic
Keele Cardiovascular Research Group University of Keele StokeonTrent UK
Pharmacology Faculty of Medicine Masaryk University Brno Czech Republic
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