Distal Versus Conventional Transradial Access in Patients With ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.

The distal radial access (DRA) is emerging as an alternative to conventional transradial access (TRA) for coronary procedures, potentially reducing vascular complications. This meta-analysis aims to compare the efficacy and safety of DRA versus TRA specifically in patients with ST-elevation myocardial infarction (STEMI). We systematically searched PubMed, Cochrane, Scopus, and Embase for randomized or observational studies comparing DRA and TRA in STEMI patients undergoing coronary angiography or percutaneous coronary intervention. Data were pooled using a random-effects model and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses were performed based on study design. Analysis included 6 studies (n = 1330), out of which 3 were randomized controlled trials. DRA was associated with a significant reduction in the risk of radial artery occlusion [RR, 0.23; (95% CI, 0.11-0.51); P < 0.01]. However, time to reperfusion was significantly longer with DRA [mean differences, +3.25 min, (95% CI, 0.93-5.57); P < 0.01]. A nonsignificant trend favored DRA for reduced hematoma risk [RR, 0.59; (95% CI, 0.33-1.06); P = 0.077]. No significant differences were found in puncture failure rates [RR, 0.99; (95% CI, 0.34-2.84); P = 0.980] or cannulation success [RR, 0.99; (95% CI, 0.94-1.04); P = 0.594]. In patients with STEMI, DRA was associated with significantly lower risk of radial artery occlusion, with a potential trend towards fewer hematomas, and without compromising puncture success or cannulation rates. The associated 3.25-minute delay in reperfusion is small relative to the ≤90-minute door-to-balloon target and is unlikely to compromise guideline adherence.