Can we predict which patients with ST-elevation myocardial infarction benefit most from radial access? Evidence from frequentist and Bayesian meta-regressions of randomized trials

摘要

Radial access is a less invasive alternative to femoral access for diagnostic or interventional coronary procedures [1]. Patients with ST-elevation myocardial infarction (STEMI) may be an ideal target for radial access [2], and recent trials have shown that radial access is beneficial also in STEMI [3,4]. Accordingly, and despite a learning curve often mistaken as too long, radial access is being used more and more in patients with STEMI. However, there is uncertainty on which patient, lesion, or procedural features may be used to identify those most likely to benefit from radial access. We thus aimed to perform a comprehensive systematic review and meta-regression.Pertinent studies were searched in MEDLINE/PubMed according to Biondi-Zoccai et al. in The Cochrane Library and Scopus. Studies were included if randomized, comparing radial/ulnar versus femoral access, in STEMI, and reporting on clinically relevant outcomes. Several study design, baseline, clinical, lesion, and procedural features were systematically abstracted, including ancillary antithrombotic therapy. End-points of interest were all-cause death, major adverse cardiovascular events (MACE, i.e. the composite of death, stroke, myocardial infarction or urgent target vessel revascularization), and major bleeding.