Distal versus traditional radial access in patients undergoing emergency coronary angiography or percutaneous coronary intervention: a systematic review and meta-analysis

Background Distal radial access (DRA) is a well-tolerated and effective alternative to traditional radial access (TRA) for coronary procedures. However, the comparative value of these modalities remains unknown in the emergency setting, particularly in patients with ST-elevation myocardial infarction (STEMI). Objective To compare DRA versus TRA for emergency coronary procedures through a meta-analysis Methods We systematically searched PubMed , Embase , and Cochrane databases to identify studies comparing DRA versus TRA in patients undergoing emergency coronary angiography (CAG) or percutaneous coronary intervention (PCI). All statistical analyses were performed using R software version 4.3.1 with a random-effects model. Results We included four studies comprising 543 patients undergoing emergency CAG or PCI, of whom 447 (82.3%) had STEMI. As compared with TRA, DRA was associated with lower radial artery occlusion rates (RR, 0.21; 95% CI, 0.06–0.72) and shorter hemostasis time (MD, −4.23 h; 95% CI, −6.23 to 2.13). There was no significant difference between modalities in terms of puncture failure (RR, 1.38; 95% CI, 0.31–6.19), crossover access (RR, 1.37; 95% CI, 0.42–4.44), puncture time (SMD, 0.33; 95% CI, −0.16 to 0.81), procedure time (MD, 0.97 min; 95% CI, −5.19 to 7.13), or rates of cannulation success (RR, 0.94; 95% CI, 0.83–1.06). In terms of other periprocedural complications, there were no differences between both groups. These findings remained consistent in a subgroup analysis of patients with STEMI. Conclusion In this meta-analysis, DRA was superior to TRA in terms of radial artery occlusion and hemostasis time, with similar rates of periprocedural complications.