An Observational Study Assessing the Predictors of Procedural Failure From the Radial Approach: Is Right Radial Access Always the Best?
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Published on: September 20, 2020
Johanna Jones1, Krishnaraj S Rathod2, Anne-Marie Beirne2
1Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, United Kingdom.
Insights
Transradial (TR) access for coronary angiography has a low failure rate. Predictors of TR failure, such as age and hypertension, differ between the right radial artery (RRA) and left radial artery (LRA) approaches, suggesting LRA as a potential alternative.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial (TR) access is a common approach for coronary angiography and percutaneous coronary intervention (PCI).
- Understanding predictors of procedural failure is crucial for optimizing patient outcomes and selecting appropriate vascular access routes.
Purpose of the Study:
- To identify predictors of procedural failure, defined as inability to cannulate coronary arteries, during transradial (TR) angiography.
- To compare predictors of failure between the right radial artery (RRA) and left radial artery (LRA) approaches.
Main Methods:
- An observational study of 20,315 consecutive patients undergoing TR angiography from 2016 to 2020.
- Univariate and multivariate analyses were used to determine independent predictors of TR failure.
Main Results:
- TR failure occurred in 1.8% of patients.
- Independent predictors of TR failure included older age, female gender, Black, Asian, and Minority Ethnic (BAME) background, shorter stature, hypertension, and RRA use.
- These predictors were not significant for LRA failure.
Conclusions:
- The rate of TR access failure in coronary angiography is low.
- Predictors of failure differ between RRA and LRA, suggesting LRA as a viable alternative access site when RRA cannulation is unsuccessful.
- Further research is warranted to evaluate LRA as a primary access route in specific patient populations.
Objective:
The study aimed to determine the predictors of procedural failure (coronary cannulation) in patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) from the transradial (TR) approach.
Methods:
We conducted an observational study of 20,315 consecutive patients undergoing TR angiography between 2016 and 2020. TR failure was described as inability to cannulate the coronary arteries. Univariate and multivariate analyses were performed to determine independent predictors of TR failure.
Results:
Out of the study population, TR failure was observed in 365 (1.8%) patients, out of which 281 (77%) crossed over successfully to the transfemoral (TF) route and 84 (23%) to left radial access (LRA). Unsuccessful procedures were most likely seen in patients who were elderly, female, BAME background, short stature or with a history of hypertension, diabetes, and renal disease. On regression analysis, age (OR: 1.024; 95% Cl: 1.014-1.035), female gender (OR: 0.729; 95% Cl: 0.555-0.957), BAME (OR: 0.786; 95% Cl: 0.612-0.959), height (OR: 0.988; 95% Cl: 0.977-0.999), hypertension (OR: 1.510; 95% Cl: 1.147-1.987) and RRA (OR: 1.977; 95% Cl: 1.105-3.538) were independent predictors of TR failure. On further analysis, these predictors of failure were not seen from the LRA approach.
Conclusion:
This study identifies that rates of TR failure are low and that predictors of failure differ between the RRA and LRA. The difference in predictors between the 2 routes suggests that in patients when coronary cannulation is unsuccessful via the RRA then the LRA could be considered as a second access site. Further study is needed to see if in selected patient groups the LRA could be used as the first-choice access route.
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