Sex differences in transradial access failure in ST segment elevation myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Transradial access (TRA) is the standard for primary percutaneous coronary intervention (PPCI).
• TRA presents technical challenges, often due to radial artery (RA) anatomy.
• Sex-based differences in RA characteristics and access success are not fully understood.

Purpose of the Study:

• To investigate sex-specific differences in radial artery access site characteristics during PPCI for ST-elevation myocardial infarction (STEMI).
• To identify predictors of TRA failure and crossover to alternative access sites in STEMI patients.

Main Methods:

• Analysis of 5092 consecutive STEMI patients undergoing PPCI with an intention-to-treat radial access approach.
• Preprocedural RA angiography, clinical data, procedural details, and complication rates were analyzed by sex.
• Logistic regression identified predictors of radial access crossover.

Main Results:

• Females (n=1326) were older and had higher rates of hypertension, diabetes, and radial artery anomalies compared to males (n=3766).
• TRA failure occurred more frequently in females (4.6%) versus males (2.5%), with higher rates of radial artery spasm in women.
• Independent predictors for TRA crossover included female sex, previous TRA, anomalous radial artery, and radial artery spasm.

Conclusions:

• Female sex is a significant predictor of more complex transradial access in STEMI patients.
• Understanding sex differences and predictors of TRA crossover is crucial for optimizing wrist access in female STEMI patients.
• Tailoring procedural strategies based on sex-specific factors can enhance successful radial access outcomes.