Transradial access (TRA) is associated with better outcomes than transfemoral access (TFA) when performing percutaneous coronary intervention (PCI) on patients with chronic kidney disease (CKD), according to a new meta-analysis published in the American Journal of Cardiology.
The study’s authors evaluated five studies that compared TRA vs. TFA in CKD patients who underwent PCI from Jan. 1, 2000, to Jan. 15, 2021. While more than 1,000 patients underwent PCI using TRA, more than 6,000 underwent PCI using TFA. Sixty-six percent of patients were men, and the mean patient age was 70.5 years old. Ninety percent of patients had end-stage renal disease on dialysis.
Overall, TRA was associated with a lower risk of all-cause mortality, bleeding events and blood transfusion compared to TFA.
"The mechanism of reduced mortality seen with TR access is probably related to decreased incidence of major bleeding and vascular access site complications," wrote first author Azka Latif, MD, an internist with Creighton University in Omaha, and colleagues. "Major bleeding leads to increased mortality by causing significant hemodynamic compromise requiring blood transfusions."
No difference was seen in the risk of stroke or myocardial infarction.
"Based on these findings, TRA may be selected over TFA in this high-risk patient population undergoing PCI," the authors concluded.
They did, however, recommend randomized clinical trials in the future that could help to confirm their findings.
Read the full meta-analysis here.