Diagnostic Yield and Safety of Invasive Coronary Function Testing After Radial Versus Femoral Access

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Procedures

Background:

• Coronary vasomotor dysfunction diagnosis relies on coronary function testing (CFT), but protocols and influencing factors like access site and medications are not fully understood.
• Variability in CFT protocols and the impact of access site (radial vs. femoral) and vasodilator use on diagnostic yield and safety require investigation.

Purpose of the Study:

• To compare the diagnostic yield and safety of CFT using radial access with intraarterial calcium channel blockers versus femoral access.
• To assess the influence of access site on the diagnostic performance and safety of coronary function testing.

Main Methods:

• Retrospective analysis of data from the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (December 2020 - July 2025).
• Inclusion of 1885 patients undergoing CFT, comparing outcomes between primary radial access (n=1436), primary femoral access (n=380), and radial-to-femoral conversion (n=69).

Main Results:

• Overall diagnostic yield for coronary vasomotor dysfunction was 78.5% with no significant difference between radial and femoral access (79.2% vs. 75.3%, P=0.1).
• Diagnostic yield was comparable between non-conversion and conversion groups (78.4% vs. 82.6%, P=0.4), though spasm was higher in the conversion group (67.7% vs. 79.4%, P=0.04).
• No significant differences in complication rates were observed across all groups.

Conclusions:

• Primary radial access with routine calcium channel blocker administration is not inferior to femoral access for CFT diagnostic yield.
• The safety profile of CFT is comparable between radial and femoral access approaches.