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.

中文翻译：

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冠状动脉手术中经股动脉通路的超声引导：来自股骨超声试验者合作的个体参与者级数据荟萃分析。

背景 用于冠状动脉手术的超声（US）引导经股动脉通路（TFA）的随机对照试验显示了不同的结果。目的 我们的目的是通过个体参与者级数据 (IPD) 荟萃分析中的随机数据来比较美国指导与非美国指导的 TFA。方法 我们对所有比较美国引导与非美国引导 TFA 冠状动脉手术的随机对照试验完成了系统评价和 IPD 荟萃分析。我们使用纳入试验中的意向治疗人群进行了一阶段混合模型荟萃分析。主要结局是 30 天内主要血管并发症或大出血的复合结果。结果 4 项随机临床试验共纳入 2,441 名参与者（1,208 名美国指导，1,233 名非美国指导）。平均年龄为 65.5 岁，27.0% 为女性，34.5% 接受过经皮冠状动脉介入治疗。主要血管并发症或大出血的发生率（34/1,208 [2.8%] vs 55/1,233 [4.5%]；比值比 [OR] 0.61，95% 置信区间 [CI]：0.39-0.94；p=0.026）为在美国引导的 TFA 组中较低。在接受血管闭合装置的预先指定的参与者亚组中，随机接受超声引导 TFA 的参与者的主要结局有所下降（2.1% vs 5.6%；OR 0.36，95% CI：0.19-0.69），而对于在没有血管闭合装置的亚组中观察到了美国指导（4.1% vs 3.3%；OR 1.21，95% CI：0.65-2.26；交互作用 p=0.009）。结论 在接受 TFA 冠状动脉手术的参与者中，超声指导降低了主要血管并发症或出血的综合结果，并且在使用血管闭合装置时可能特别有帮助。