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Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial
David A Manly1, Wassef Karrowni2, Jennifer A Rymer3
1Prisma Health-Upstate, Greenville Memorial Medical Campus, Greenville, South Carolina, USA.
Insights
Transradial access for patients after coronary artery bypass grafting (CABG) is increasing and linked to better outcomes. This approach offers reduced mortality, bleeding, and vascular complications compared to transfemoral access.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Access
Background:
- Limited data exist comparing transradial versus transfemoral access outcomes in patients with prior coronary artery bypass grafting (CABG).
- Understanding procedural trends and outcomes is crucial for optimizing care in this patient population.
Purpose of the Study:
- To examine radial artery access rates in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catheterization and/or percutaneous coronary intervention (PCI).
- To determine if operator experience and radial approach preference influence radial access use in post-CABG patients.
- To compare clinical and procedural outcomes between radial and femoral access in post-CABG patients.
Main Methods:
- Analysis of 1,279,058 diagnostic catheterizations and PCIs in patients with prior CABG from the National Cardiovascular Data Registry CathPCI Registry (July 2009–March 2018).
- Evaluation of temporal trends in transradial access.
- Comparison of mortality, bleeding, vascular complications, and procedural metrics between transradial and transfemoral access.
Main Results:
- Transradial access rates increased from 1.4% to 18.7% over the study period.
- Transradial access was associated with significantly lower mortality (OR: 0.83), bleeding (OR: 0.57), and vascular complications (OR: 0.38).
- Improved PCI success (OR: 1.11), reduced contrast volume, and varied fluoroscopy times were observed with transradial access.
Conclusions:
- Transradial artery access in post-CABG patients undergoing cardiac procedures has risen significantly in the U.S.
- Operators with higher radial use in non-CABG patients were more likely to use it in post-CABG patients.
- Transradial access demonstrates superior clinical outcomes compared to transfemoral access in patients with prior CABG.
Objectives:
The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach.
Background:
There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI.
Methods:
Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access.
Results:
The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG.
Conclusions:
The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.
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