Introduction: Limited data is available on comparison of outcomes among transradial (TR) and transfemoral (TF) access of percutaneous coronary intervention (PCI) in End Stage Renal Disease (ESRD). Hypothesis: Which access route is better for better cardiovascular outcomes or lower procedural complications among ESRD patients. Methods: Online databases including MEDLINE and Cochrane Central were queried to compare cardiovascular outcomes among TR and TF in ESRD patients. The primary outcome of this meta-analysis was to compare the bleeding complications and in-hospital mortality difference between TR PI and TF PCI in patients with ESRD. The secondary outcomes included differences in Mortality, Cardiovascular accident (CVA), Myocardial infarction (MI), Bleeding, Transfusion, Cardiogenic shock, and Heart failure. Unadjusted odds ratios (OR) were calculated using a random effect model with a 95% confidence interval (CI) and P <0.05 as a statistical significance. Results: A total of 5 studies including 7383 patients ( TR-PCI = 1208 ; TF-PCI = 6275) were included in this analysis. The overall mean age was 70 years; while the mean for TR-PCI and TF-PCI was 71 years and 69.1 years respectively. TR-PCI was associated with lower odds of bleeding (OR 0.48 95% CI 0.33, 0.69, p<0.05, I2 0.00%) (Figure 1A), transfusion requirement (OR 0.52 95% CI 0.40, 0.68, p<0.05, I2 0.00%), and mortality (OR 0.41 95% CI 0.26, 0.66, p<0.05, I2 0.00%) (Figure 1B). We did not find any statistically significant difference in CVA (OR 1.06 95% CI 0.37, 3.00 p>0.05, I2 0.00%), MI (OR 0.97 95% CI 0.57, 1.63, p>0.05, I2 0.00%), CS (OR 0.53 95% CI 0.06, 4.42, p>0.05, I2 48.48%) between TR and TF PCI in ESRD population. We didn’t find any effect modifier in our study on regression analysis. Conclusions: TR access is associated with better cardiovascular outcomes as compared to TF access PCI in ESRD patients with any coronary artery disease.
