Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of XXXX .

@entity1 @entity23
BACKGROUND: Although transfemoral access (TFA) remains the standard of care for @entity1 undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) in the USA, TRA is being increasingly used over TFA due to lower bleeding and mortality rates on the basis of meta-analyses and recently published MATRIX trial. In @entity1 with unsuccessful ipsilateral radial access, TUA has been used as an alternative approach. The @entity23 ( @entity23 ) comparing TUA and TRA have reached mixed conclusions regarding the use of transulnar approach for coronary procedures. OBJECTIVES: To systematically review and perform a meta-analysis of published @entity23 comparing the safety and efficacy of transulnar access (TUA) vs. transradial access (TRA) in @entity1 undergoing CA or PCI. METHODS: PubMed, EMBASE, and CENTRAL databases were searched for @entity23 since inception through December, 2014. Meta-analysis was performed using random-effects model. RESULTS: Five @entity23 involving 2,744 total @entity1 were included in the meta-analysis. TUA compared with TRA had similar risks of MACE [risk ratio (RR): 0.87; 95% confidence interval (CI): 0.56-1.36; P   =   0.54] and access-related complications [RR: 0.92 (0.67-1.27); P   =   0.62]. Higher rates of access cross-over [RR: 2.31 (1.07-4.98); P   =   0.003] and number of punctures [1.57 vs. 1.4; mean difference (MD): 0.17; 95% CI: 0.08-0.26; P   =   0.0002] were noted with TUA. There was no difference in arterial access time [12.8 vs. 10.9 min; MD: 1.86 (-1.35-5.7); P   =   0.26], fluoroscopy time [7.6 vs. 7.2 min; MD: 0.37 (-0.39   -   1.13); P   =   0.34] and contrast volume [151 vs. 153.7 ml; MD: -2.74 (-17.21   -   11.73); P   =   0.71]. CONCLUSION: For @entity1 requiring CA or PCI, TUA compared with TRA has similar efficacy and safety except for higher puncture rates and access cross-over.    2015 Wiley Periodicals, Inc.
