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

J 2023

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

TUZIL, Jan, Jan MATEJKA, Mamas A A MAMAS and Tomáš DOLEŽAL

Basic information

Original name

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

Authors

TUZIL, Jan (203 Czech Republic, guarantor), Jan MATEJKA (203 Czech Republic), Mamas A A MAMAS and Tomáš DOLEŽAL (203 Czech Republic, belonging to the institution)

Edition

EXPERT REVIEW OF CARDIOVASCULAR THERAPY, PHILADELPHIA, TAYLOR & FRANCIS INC, 2023, 1477-9072

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.000 in 2022

RIV identification code

RIV/00216224:14110/23:00133372

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1080/14779072.2023.2187378

UT WoS

000945424600001

Keywords in English

Stroke; catheterization; radial; femoral; incidence; observational; cohort; real-world; accession site; meta-analysis; meta-regression; trial sequential analysis

Abstract

V originále

ObjectivesTo verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS).MethodsWe 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).ResultsThe 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; I-2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I-2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I-2 = 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.ConclusionPeriprocedural 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.

Citovat

TUZIL, Jan, Jan MATEJKA, Mamas A A MAMAS and Tomáš DOLEŽAL. 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. EXPERT REVIEW OF CARDIOVASCULAR THERAPY. PHILADELPHIA: TAYLOR & FRANCIS INC, 2023, vol. 21, No 4, p. 293-304. ISSN 1477-9072. Available from: https://dx.doi.org/10.1080/14779072.2023.2187378.

@article{2368545,
   author = {Tuzil, Jan and Matejka, Jan and Mamas, Mamas A A and Doležal, Tomáš},
   article_location = {PHILADELPHIA},
   article_number = {4},
   doi = {http://dx.doi.org/10.1080/14779072.2023.2187378},
   keywords = {Stroke; catheterization; radial; femoral; incidence; observational; cohort; real-world; accession site; meta-analysis; meta-regression; trial sequential analysis},
   language = {eng},
   issn = {1477-9072},
   journal = {EXPERT REVIEW OF CARDIOVASCULAR THERAPY},
   title = {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},
   url = {https://www.tandfonline.com/doi/full/10.1080/14779072.2023.2187378},
   volume = {21},
   year = {2023}
}

TY  - JOUR
ID  - 2368545
AU  - Tuzil, Jan - Matejka, Jan - Mamas, Mamas A A - Doležal, Tomáš
PY  - 2023
TI  - 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
JF  - EXPERT REVIEW OF CARDIOVASCULAR THERAPY
VL  - 21
IS  - 4
SP  - 293-304
EP  - 293-304
PB  - TAYLOR & FRANCIS INC
SN  - 14779072
KW  - Stroke
KW  - catheterization
KW  - radial
KW  - femoral
KW  - incidence
KW  - observational
KW  - cohort
KW  - real-world
KW  - accession site
KW  - meta-analysis
KW  - meta-regression
KW  - trial sequential analysis
UR  - https://www.tandfonline.com/doi/full/10.1080/14779072.2023.2187378
N2  - ObjectivesTo verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS).MethodsWe 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).ResultsThe 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; I-2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I-2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I-2 = 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.ConclusionPeriprocedural 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.
ER  -

TUZIL, Jan, Jan MATEJKA, Mamas A A MAMAS and Tomáš DOLEŽAL. 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. \textit{EXPERT REVIEW OF CARDIOVASCULAR THERAPY}. PHILADELPHIA: TAYLOR \&{} FRANCIS INC, 2023, vol.~21, No~4, p.~293-304. ISSN~1477-9072. Available from: https://dx.doi.org/10.1080/14779072.2023.2187378.

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