Transulnar versus transradial access for coronary angiography and percutaneous coronary intervention: A meta-analysis of randomized controlled trials.

Abstract Objectives To compare the outcomes of transulnar access (TUA) versus transradial access (TRA) for coronary angiography (CA) and percutaneous coronary intervention (PCI). Background TUA has emerged as an alternative access site in patients who fail TRA or not candidates for it. Data comparing both approaches have been limited. Methods We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared outcomes of TUA versus TRA for CA and/or PCI. Results Data from seven RCTs, with 5,721 patients (TUA = 2,874 and TRA = 2,847), were analyzed. TUA, compared with TRA, was associated with a similar risk of major adverse cardiovascular and cerebrovascular events (MACCE) (3.05% vs. 3.32%, OR 0.9, 95% CI [0.65, 1.25]; P=0.53), access cross-over rate (9.4% vs. 4.1%, OR 1.92, 95% CI [0.91, 4.06]; P=0.09), access-site complications (12.7% vs. 13%, OR 0.97, 95% CI [ 0.79, 1.19]; P=0.75), vasospasm (8.1% vs. 9%, OR 0.83, 95% CI [0.54, 1.27]; P=0.38), procedural time (MD 1.34 minutes, 95% CI [-1.31, 3.99]; P=0.32) and fluoroscopy time (MD 0.29 minutes, 95% CI [-0.33, 0.91]; P=0.36). Additional analysis of patients who underwent PCI showed no difference in the incidence of MACCE, access-site complications and large hematoma. The risk of local bleeding was lower in the TUA group compared with TRA (4.9% vs. 8.5%, OR 0.55, 95% CI [0.33, 0.93]; P = 0.02). Conclusion TUA is a safe approach in both CA and PCI with comparable outcomes to TRA. PCI with TUA might be associated with a lower risk of local bleeding compared with TRA.