Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

Para superar el estancamiento económico en México: "nudos críticos" de un proyecto nacional de desarrollo

This article is devoted to analyze changes in economic policy to be adopted by Mexico if a national development project were implemented. Starting from an evaluation of the main economic and political outcomes of Vicente’s Fox administration, the author proposes an alternative development strategy which permits Mexico to overcome economic stagnation. That strategy would be based in recovering the internal market as the dynamical focus of the economy with the purpose of satisfying basic needs of people. To be successful this strategy should to confront the "critical knots" of the Neo-liberal model: to reverse the uneven distribution of income; abandoning the fixing of restrictive monetary, fiscal and exchange rate policies; and mobilizing economic surplus by means of a profound revision of debt service schemes. It concludes that to implement a national development project it is required a political and economic strategy to dismantle neoliberalism, which is an antinational structure of power.