Supplementary Material for: Efficacy and Safety of Distal Radial Artery Access versus Proximal Radial Artery Access for Cardiac Procedures: A Systematic Review and Meta-analysis

Objective: Cardiac catheterization using the distal radial artery access (DRA), at the level of the anatomical snuff box post radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery access (PRA) in cardiac catheterization or angiography. Methods: A detailed literature search was performed on PubMed, Cochrane, Embase and Clinicaltrials.gov from inception till June 2024. Risk ratios (RR) and mean differences (MD) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on Revman. Results: Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-hour radial artery occlusion (RAO) rates (RR 0.30, 95% CI 0.23 to 0.40, p ≤ 0.00001), and time to hemostasis (minutes) (MD -44.46, 95% CI -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI 2.02 to 4.15, p < 0.00001, and puncture attempts (MD 0.69, 95% CI 0.37 to 1.00, p = 0.00001). Conclusion: DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.