Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

Table 3 Summary of findings (the efficacy and safety of the radial approach vs the distal radial approach for diagnostic coronary angiography and percutaneous coronary intervention)

Patient or population: Adults; Setting: Diagnostic coronary angiography and percutaneous coronary intervention; Intervention: Radial approach (RA); Comparison: Distal radial approach (DRA)
Outcomes	Anticipated absolute effects1 (95%CI)		Relative effect (95%CI)	Patient number (studies)	Certainty of the evidence, GRADE	Comments
	Risk with RA	Risk with DRA
Successful cannulation rates	950 per 1000	798 per 1000 (532-1000)	RR 0.90 [0.72-1.13]	519 (3 RCTs)	Low2,3	DRA resulted in little to no difference in successful cannulation rates
Radial artery spasm	39 per 1000	16 per 1000 (4-56)	RR 0.43 [0.08-2.49]	405 (2 RCTs)	Low3	DRA may reduce incidence of radial artery spasm
Radial artery occlusion	32 per 1000	14 per 1000 (5-41)	RR 0.48 [0.18-1.29]	314 (2 RCTs)	Low3	DRA may reduce the incidence of radial artery occlusion
Mean number of punctures per patient	The mean number of punctures per patient were 2.4 in DRA in comparison to 1.6 in RA			200 (1 RCT)	Low3	DRA may reduce the mean number of punctures per patient
Mean time for hemostasis	-	MD 6.64 min lower (10.37 lower to 2.9 lower)	-	405 (2 RCTs)	Very low2,3,4	DRA reduced mean time for hemostasis

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% confidence interval). GRADE Working Group grades of evidence: High certainty: Very confident that the true effect lies close to that of the estimated effect. Moderate certainty: Moderately confident in the estimated effect. The true effect is likely to be close to the estimated effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the estimated effect is limited: The true effect may be substantially different from the estimated effect. Very low certainty: We have very little confidence in the estimated effect. The true effect is likely to be substantially different from the estimated effect.

²Downgraded because of inconsistency due to substantial heterogeneity.

³Downgraded because of imprecision due to small sample size and/or small number of participants.

⁴Downgraded due to imprecision because of high risk of bias.

CI: Confidence interval; MD: Mean difference; RCT: Randomized-controlled trial.