Bleeding, length of stay, and mortality following primary coronary interventions : radial versus femoral access

Abstract

Topic Overview: A percutaneous coronary intervention is one of the leading procedures done worldwide. By undergoing such procedure patients have an increased risk of major bleeding, mortality, and an increased stay at the hospital. Required was to find out which access between the radial and femoral, hold the most risk when used. Research Question: In patients undergoing a percutaneous coronary intervention with either angiography or angioplasty which access between the radial access and femoral access when compared is associated with a higher risk of major bleeding, mortality and hospitalisation stay PICO elements: The population studied were patients undergoing a percutaneous coronary intervention with either angiography or angioplasty use. The expected outcome was to find which access had the highest risk between the radial and femoral. Inclusion and Exclusion criteria: The inclusion criteria set was comparison of the radial and femoral access, English language, patients undergoing a PCI, last ten years publishing’s, Randomized controlled trials, Systematic reviews and meta-analysis, trials, and cohort studies. Exclusion criteria set was any other language, patients under the age of 18, publishing’s before 2011, articles with no comparison, journals, special editions, editorials, and critical answers. Outcome of the search: Three systematic reviews and meta-analysis and two retrospective cohort studies were found and used. Methods of appraisal: Several search terms were developed along with limiters to develop a specific search term to be used in databases. The Prisma flow diagram was used to explain how the articles were reduced to five. CASP tools for systematic reviews and meta-analysis and cohort studies were used to assess and verify the strength and weakness of the articles chosen. The hierarchy of evidence was used to select where each article found lie in terms of validity and strength. Articles then were critically appraised, and the findings were discussed. Results: Key studies consisted of three systematic reviews and meta-analysis and two cohort studies were found relevant. Results of the studies did answer the question as articles found the access with the lowest risk that was the radial and hence, the other access femoral had the highest risk. Main conclusion: The radial access was the access with most risk reduction while the femoral access was the access with the highest chance of risk in patients undergoing a percutaneous coronary intervention. Implications and recommendations: Recommendations for further research include finding more research on the local population and using articles that have clearer findings. More education to the patients and staff is to be giving to keep up with any updates in research that may arise.