Abstract 16258: Implementation of the Transradial Approach for Coronary Procedures is Not Associated With an Elevated Complication Rate and Prolonged Procedure Times
Background: The transradial (TR) approach for coronary procedures is associated with a lower complication rate at the access site compared to the transfemoral (TF) approach. Despite these favorable data, TR procedures are still infrequently performed. The TR approach was generally considered to require training for implementation.
Methods: We investigated complication rates and procedural characteristics (contrast dye: CD [ml]; fluoroscopy time: FT [min]) during implementation of the TR approach. The study was divided into a period of implementation (2008-IP; N=160) and evaluation (2009-EP). In the EP, the procedural characteristics were compared between TR (N=624) and TF (N=842). All operators including fellows performed TR approach
Results: The amount of CD used for TR coronary angiography was similar during IP (75 ml [IQR 60–100]) and EP (70 ml [55–100]; p=0.63). In contrast, FT of TR coronary angiography was slightly but significantly reduced from IP (4.4 min [3.2–6.8]) to EP (4.1 min [2.7–6.5]; p=0.04). Safety data showed a low complication rate: 0.2% access failure, 0.1% dissection, 0.7% vessel closure. The prospective comparison between TF and TR procedures revealed prolonged FT for TR procedures (TF 2.9 min [1.7–5.5]; TR 4.1 min [2.7–6.5]; p<0.01), whereas CD was similar (TF 70 ml [55–100]; TR 70 ml [55–100]; p=0.25). However, the prolonged FT was restricted to coronary angiography, but did not differ for PCI procedures (TF 9.7 [5.8–18.1]; TR 8.9 [5.3–16.5]; p=0.43). The major cause of overall procedural failure (defined as need for change in access site) in the TR group was the incidence of spasm, limiting peripheral vascular or coronary anatomy (IP 11.3% EP 12.2% p=0.89). Female gender was associated with a nearly 60% higher risk of radial procedural failure. Other adverse predictors included LVEF < 35% and age >75 years. The strongest independent predictor of radial procedural failure was the omission of intra-arterial verapamil application due to contraindications (HR=6.51, 95%CI [3.96–10.73).
Conclusions: A transradial program can be implemented without adverse effects for patients. Given the excellent safety profile, the TR approach should be preferred in suitable patients.
- © 2010 by American Heart Association, Inc.