Research shows superiority of radial arterial access in coronary interventions

New data demonstrate the superiority of radial arterial access compared to femoral arterial access for coronary interventions. Findings showed that radial access was associated with lower in-hospital mortality rates, major access bleeding, and other major vascular complications compared with femoral access. The latest results were presented today at the Society for Cardiovascular Angiography & Interventions (SCAI) Scientific Sessions 2024.

Historically, femoral arterial access, via the groin, for percutaneous coronary intervention (PCI) was the standard. Radial access, or the use of the radial artery in the wrist as an access point for the catheter, is an alternative and offers potential benefits, including fewer bleeding complications, fewer infections, and readmissions. Although recent research supports these benefits, the broader application 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 evaluated using instrumental variable analysis, using made of inter-operator variation in access preferences.

During the study period, 6,658,479 PCI procedures were performed, of which 40.4% (n= 2,690,355) were performed via radial access, an increase from 20.3% in 2013 to 57.5% in 2022, representing a 2.8-fold increase in the last ten years. This increase was observed across all geographic regions and across the full spectrum of presentations, with the greatest relative increase observed in patients with ST-segment elevation myocardial infarction.

2,244,115 PCIs met inclusion criteria for the instrumental variables analysis, which showed that radial access was associated with lower in-hospital mortality (absolute risk difference (ARD) of -0.15%, P<0.001), major access site bleeding (ARD of -0.64%), P<0.001), and other major vascular complications (ARD of -0.21%, P<0.001) but a higher risk of ischemic stroke (ARD of 0.05%, P<0.001) 0.001). There was no association with the adulteration endpoint of gastrointestinal or genitourinary bleeding (P = 0.89).

The study demonstrates a major change in the way PCI is performed in the US in response to trial data, but also highlights the continued opportunity for practice improvement with dramatic variations between operators. It confirms that the benefit observed in RCTs for radial access has also been observed in practice, including the greatest benefits for patients at highest risk. Finally, it shows a very credible 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:

• “Temporal Trends and Clinical Outcomes with Radial Versus Femoral Arterial Access for Percutaneous Coronary Intervention in the United States”
• Friday May 2, 2024; 9:17am-9:24am PT
• Long Beach Convention Center, 104A, first level