Latest data display the prevalence of radial artery access over femoral artery access for coronary interventions. The outcomes showed that the radial approach was related to lower rates of in-hospital mortality, major access bleeding, and other major vascular complications compared with the femoral approach. The breakthrough results were presented today on the Society for Cardiovascular Angiography and Interventions (SCAI) 2024 Scientific Sessions.

Historically, transgroin access to the femoral artery for percutaneous coronary intervention (PCI) has been the usual. Radial access, using the radial artery within the wrist as a catheter entry point, is an alternate and provides potential advantages reminiscent of reduced bleeding complications, infection rates, and hospital readmissions. Although recent research supports these benefits, the broader use of transradial PCI in the USA is unknown.

The retrospective cohort study used data from the CathPCI registry of the National Cardiovascular Data Registry, including PCI performed in 2013–2022. The comparative safety of radial and femoral access for PCI was assessed using an instrumental variable evaluation making the most of differences in operator preferences.

In the course of the study period, 6,658,479 PCI procedures were performed, of which 40.4% (n= 2,690,355) were performed via radial access, a rise from 20.3% in 2013 to 57.5% in 2022. , which represents a 2.8-fold increase over the past decade. This increase was observed in all geographic regions and across the total spectrum of cases, with the best relative increase observed in patients with ST-segment elevation myocardial infarction.

2,244,115 PCI met inclusion criteria for the instrumental variable evaluation, which showed that radial access was related to lower in-hospital mortality (absolute risk difference [ARD] -0.15%, p < 0.001), major bleeding on the access site (ARD -0.64%, p < 0.001) and other major vascular complications (ARD -0.21%, p < 0.001), but risk of ischemic stroke is higher (ARD 0.05%, P<0.001). There was no association with the false endpoint of gastrointestinal or urogenital bleeding (p=0.89).

The study shows a dramatic shift in how PCI is performed within the U.S. in response to trial data, but in addition highlights ongoing opportunities for practice improvement with dramatic inter-operator differences. This confirms that the advantages observed with radial access in RCTs were also observed in real-world practice, with the best advantages for the highest-risk patients. Finally, it presents a highly credible latest finding regarding increased risk of stroke.”

Reza Fazel, MD, FSCAI, a cardiologist at Beth Israel Deaconess Medical Center and lead writer of the study

Session details:

• “Time Trends and Clinical Outcomes with Radial and Femoral Artery Access for Percutaneous Coronary Intervention in the USA.”
• Friday, May 2, 2024; 9:17–9:24 Pacific Time
• Long Beach Convention Center, 104A, first level