Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI) | Heart and Vascular Health | Scoop.it

Transradial arterial access significantly lowers the risk of access site complications compared to transfemoral arteriotomy. 

 We analyzed 17 509 patients who underwent PCI at 5 institutions. Transradial arterial access was used in 17.8% of patients. In those who underwent transfemoral access, 177 (1.2%) patients had access site complications. Using preprocedural clinical and demographic data, a prediction model for femoral arteriotomy complications was generated. The variables retained in the model:

- elevated age (P<0.001)

- female gender (P<0.001

- elevated troponin (P<0.001)

- decreased renal function or dialysis (P=0.002)

- emergent PCI (P=0.01)

- prior PCI (P=0.005)

- diabetes (P=0.008)

- peripheral artery disease (P=0.003).

Patients with higher predicted risk of complications via transfemoral access were less likely to receive transradial access (P<0.001). Similar results were seen in patients presenting with and without ST‐segment myocardial infarction and when adjusting for individual physician operator.

Conclusions Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access.