Use of the CHA₂DS₂-VASc Score in Assessing Transradial Approach Failure

Radial access is now considered the preferred approach for coronary angiography and percutaneous coronary intervention because of the low risk of vascular complications. However, radial access failure is not uncommon, leading to crossover to a different access site. The CHA₂DS₂-VASc score is used to estimate stroke risk in patients with atrial fibrillation. Our study aimed to assess the CHA₂DS₂-VASc score in predicting failure of the transradial approach, resulting in crossover to transfemoral access (TFA) for coronary angiography.

We performed a single-center, non-randomized, retrospective study. The study included 1775 patients who underwent coronary angiography with or without subsequent percutaneous intervention between July 2018 and October 2019. The study population was divided into three groups based on the CHA₂DS₂-VASc score: low (≤2), intermediate (3-4), and high score (≥5) groups. The association between the CHA₂DS₂-VASc score and radial access failure was evaluated and compared between the groups.

A total of 197 patients (11.1%) had crossover to the femoral artery. A large percentage of patients (19.2%) had radial access failure in the high CHA₂DS₂-VASc score group (≥5) compared with 12.5% in the intermediate score group (3-4) and only 6.3% in the low score group (≤2). The highest crossover rate (42.9%) was observed in patients with a CHA₂DS₂-VASc score of 8. Higher CHA₂DS₂-VASc scores were also associated with increased fluoroscopy time, contrast administration, and radiation exposure.

The CHA₂DS₂-VASc score can predict failure of the transradial approach, with a score of ≥5 having the highest correlation of failure requiring crossover to TFA.