Ultrasound guidance for transfemoral access in coronary procedures: an individual participant-level data meta analysis from the femoral ultrasound trialist collaboration

DOI: 10.4244/EIJ-D-22-00809

Marc-André d'Entremont
Marc-André d'Entremont1,2,3, MD, MPH; Sulaiman Alrashidi3, MD; Arnold H. Seto4, MD, MPA; Phong Nguyen5,6, MBBS, PhD; Guillaume Marquis-Gravel7, MD, MSc; Mazen S. Abu-Fadel8, MD, MBA; Craig Juergens6,9, MBBS, DMedSc; Pierre Tessier10, MD, MSc; Samuel Lemaire-Paquette2, MSc; Laura Heenan1, MSc; Elizabeth Skuriat1, MSc; Jessica Tyrwhitt1, BSc; Étienne L. Couture2, MD, MPH; Simon Bérubé2, MD; Sanjit S. Jolly1,3, MD, MSc
1. Population Health Research Institute, Hamilton, ON, Canada; 2. Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada; 3. McMaster University, Hamilton, ON, Canada; 4. Long Beach VA Medical Center, Long Beach, CA, USA; 5. Western Sydney University, Campbelltown, NSW, Australia; 6. University of New South Wales, Sydney, NSW, Australia; 7. Montreal Heart Institute, Montreal, QC, Canada; 8. Oklahoma Heart Hospital, Oklahoma City, OK, USA and University of Oklahoma, Norman, OK, USA; 9. Liverpool Hospital, Liverpool, NSW, Australia; 10. Hôpital du Sacré-Coeur-de-Montréal, Montreal, QC, Canada

Background: Randomised controlled trials of ultrasound (US)-guided transfemoral access (TFA) for coronary procedures have shown mixed results.

Aims: We aimed to compare US-guided versus non-US-guided TFA from randomised data in an individual participant-level data (IPD) meta-analysis.

Methods: We completed a systematic review and an IPD meta-analysis of all randomised controlled trials comparing US-guided versus non-US-guided TFA for coronary procedures. We performed a one-stage mixed-model meta-analysis using the intention-to-treat population from included trials. The primary outcome was a composite of major vascular complications or major bleeding within 30 days.

Results: A total of 2,441 participants (1,208 US-guided, 1,233 non-US-guided) from 4 randomised clinical trials were included. The mean age was 65.5 years, 27.0% were female, and 34.5% underwent a percutaneous coronary intervention. The incidence of major vascular complications or major bleeding (34/1,208 [2.8%] vs 55/1,233 [4.5%]; odds ratio [OR] 0.61, 95% confidence interval [CI]: 0.39-0.94; p=0.026) was lower in the US-guided TFA group. In the prespecified subgroup of participants who received a vascular closure device, those randomised to US-guided TFA experienced a reduction in the primary outcome (2.1% vs 5.6%; OR 0.36, 95% CI: 0.19-0.69), while no benefit for US guidance was observed in the subgroup without vascular closure devices (4.1% vs 3.3%; OR 1.21, 95% CI: 0.65-2.26; interaction p=0.009).

Conclusions: In participants undergoing coronary procedures by TFA, US guidance decreased the composite outcome of major vascular complications or bleeding and may be especially helpful when using vascular closure devices.

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femoral arterial accesspercutaneous coronary interventionultrasoundvascular complications
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