New data demonstrate the superiority of radial arterial access compared with femoral arterial access for coronary procedures. Findings showed that radial access was associated with lower rates of in-hospital mortality, major access bleeding, and other major vascular complications compared with femoral access. The late results were presented today at the Society of Cardiovascular Angiography & Interventions (SCAI) 2024 Scientific Sessions.
Historically, femoral arterial access, through the groin, for percutaneous coronary intervention (PCI) has been the standard. Radial access, or using the radial artery in the wrist as an entry point for the catheter, is an alternative and provides potential benefits such as reduced bleeding complications, infection rates, and readmissions. While recent research supports these advantages, the wider adoption of transradial PCI in the US is unknown.
The retrospective cohort study used data from the CathPCI Registry of the National Cardiovascular Data Registry, including PCIs performed between 2013 and 2022. The comparative safety of radial versus femoral access for PCI was assessed using instrument variable analysis that exploits variation in access preferences of operator.
During the study period, 6,658,479 PCI procedures were performed, of which 40.4% (n= 2,690,355) were performed via radial access, increasing from 20.3% in 2013 to 57.5% in 2022, representing an increase of 2.8 times in the last decade. This increase was observed in all geographic regions and across the spectrum of presentations, with the greatest relative increase seen in patients with ST-segment elevation myocardial infarction.
2,244,115 PCIs met the inclusion criteria for the organ variable analysis, which showed that radial access was associated with lower in-hospital mortality (absolute risk difference [ARD] -0.15%, P<0.001), major access site bleeding (ARD of -0.64%, P<0.001) and other major vascular complications (ARD -0.21%, P<0.001) but higher risk of ischemic stroke of episode (ARD 0.05%, P< 0.001). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (P= 0.89).
The study demonstrates a major shift in how PCI is performed in the US in response to trial data, but also highlights the continued opportunity to improve practice with dramatic variation among operators. It confirms that the benefit observed for radial access in RCTs has also been observed in real-world practice, including greater benefits for higher-risk patients. Finally, it shows a highly reliable new finding in the increased risk of stroke.”
Reza Fazel, MD, FSCAI, cardiologist at Beth Israel Deaconess Medical Center and lead author of the study
Session details:
- “Time trends and clinical outcomes with radial versus femoral arterial access for percutaneous coronary intervention in the United States”
- Friday, May 2, 2024; 9:17-9:24 am
- Long Beach Convention Center, 104A, First Level
