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
Language English Country Great Britain, England Media print-electronic
Document type Systematic Review, Meta-Analysis, Journal Article
- Keywords
- Stroke, accession site, catheterization, cohort, femoral, incidence, meta-analysis, meta-regression, observational, radial, real-world, trial sequential analysis,
- MeSH
- Femoral Artery MeSH
- Radial Artery MeSH
- Stroke * epidemiology etiology prevention & control MeSH
- Percutaneous Coronary Intervention * methods MeSH
- Humans MeSH
- Catheterization, Peripheral * methods MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Cardiac Catheterization adverse effects methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review 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
References provided by Crossref.org
