Predictors of Radial to Femoral Artery Crossover During Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

Abstract

Background: Radial access for primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding, when compared to femoral access. However, radial access failure may be associated with an increased door-to-balloon time. Objective(s): To identify predictors of radial access failure requiring crossover to femoral access during PPCI. Method(s): A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with searches from medical databases for primary research published after 2011. Studies were included if they reported predictors of transradial to transfemoral access site crossover. Result(s): Eight observational studies met the inclusion criteria, comprising 15,681 STEMI patients. Mean age was 61.2+/-12.0 years and 75.3% were male. Primary transradial access was chosen in 13,611 patients (83.4%), of whom 529 (3.9%) experienced crossover to transfemoral access. Reasons for radial access failure included failed puncture (35.3%), peripheral occlusion or tortuosity (24.5%), and radial artery spasm (20.1%). Predictors of radial-to-femoral crossover included older age (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.44-2.65 [p<0.001]), female sex (OR, 2.10; 95% Cl, 1.58-2.80 [p<0.001]), weight <=65 kg (OR, 2.95; 95% CI, 1.95-4.46 [p<0.001]), and previous PCI (OR, 2.80; 95% Cl, 1.74-4.52 [p<0.001]). Conclusion(s): In patients treated with PPCI for STEMI, recognising predictors of crossover can guide up-front femoral access selection when radial access has a high chance of failure. Identifying patients at increased risk for radial access failure is critically important to optimise door-to-balloon time.Copyright © 2021