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The learning curve of the distal radial access for coronary intervention
Ji Woong Roh1, Yongcheol Kim2, Oh-Hyun Lee1
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Republic of Korea.
Insights
Distal radial access (DRA) for coronary procedures is effective, with a 95.2% success rate. Achieving over 94% success requires 200 cases, with higher failure rates in women and patients with low blood pressure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Access Techniques
Background:
- Distal radial access (DRA) is emerging for coronary angiography (CAG) and percutaneous coronary intervention (PCI) due to reduced complications.
- Initiating DRA presents challenges despite its benefits.
Purpose of the Study:
- To evaluate the success rate of DRA in CAG and PCI procedures.
- To identify predictors of DRA failure.
Main Methods:
- Retrospective analysis of 1000 patients undergoing CAG and PCI via DRA by a single experienced operator.
- Primary outcome: DRA success rate per 100 cases.
- Analysis of factors predicting DRA failure.
Main Results:
- Overall DRA success rate was 95.2% (952/1000 patients).
- Success rate exceeded 94% after 200 procedures, with no significant trend change (P=0.216).
- Predictors of failure included female sex (OR 1.84) and systolic blood pressure <120 mmHg (OR 1.87).
Conclusions:
- Approximately 200 procedures are needed to achieve a stable DRA success rate exceeding 94%.
- DRA may be less successful in women and patients with low systolic blood pressure.
Abstract:
Recently, coronary angiography (CAG) and percutaneous coronary intervention (PCI) via the distal radial access (DRA), are gaining attention owing to fewer complications. Despite the advantages of the DRA, there is difficulty to initiate this new vascular approach. The data from 1000 patients who underwent CAG and PCI via the DRA by a single experienced radial operator were retrospectively analyzed. The primary outcome was the success rate of the DRA per 100 cases. Moreover, the predictors of the failed DRA were analyzed. Overall, 952 (95.2%) of the total 1,000 patients underwent a successful DRA. After experiencing 200 cases, the DRA success rate was well maintained at > 94%, and there was no difference in success rate per 100 cases (Ptrend = 0.216). The predictors of failure were female sex [odds ratio (OR) 1.84, 95% confidence interval (CI) 1.01-3.39, P = 0.049] and systolic blood pressure (SBP) of < 120 mmHg (OR 1.87, 95% CI 1.04-3.36, P = 0.036). For achieving a stable DRA with the success rate of > 94%, 200 procedures would be needed. Moreover, this new approach could fail in women and patients with low SBP.Trial registration: https://cris.nih.go.kr/cris/index/index.do (Unique identifier: KCT0005349).
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