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Diagnostic Yield and Safety of Invasive Coronary Function Testing After Radial Versus Femoral Access
Fleur W Adriaansen1, Caïa Crooijmans1, Tijn P J Jansen1
1Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.W.A., C.C., T.P.J.J., B.Y., J.H.C., N.v.R., S.E.E.-S., A.C.D.-L., P.D.).
Insights
Coronary function testing (CFT) using radial access with calcium channel blockers is as effective and safe as femoral access for diagnosing coronary vasomotor dysfunction. This approach maintains diagnostic yield and procedural safety, offering a viable alternative.
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.
Background:
Coronary vasomotor dysfunction is diagnosed by a coronary function testing (CFT). However, protocols vary, and the influence of access site and concomitant vasodilator medication on the diagnostic yield and safety of CFT is unclear. This study assessed the diagnostic yield and safety of CFT by radial access with intraarterial calcium channel blockers compared with CFT by femoral access.
Methods:
Data were obtained from the Netherlands Registry of Invasive Coronary Vasomotor Function Testing, a Dutch multicenter collaboration on CFT. Patients who underwent CFT between December 2020 and July 2025 were included.
Results:
A total of 1885 patients were included, 1436 (76.2%) with primary radial access and 380 (20.2%) with primary femoral access. In 69 (3.7%) patients conversion from radial to femoral access was necessary. The conversion group was analyzed separately. The total diagnostic yield of coronary vasomotor dysfunction was 78.5%. There was no significant difference in the prevalence of coronary vasomotor dysfunction between patients with primary radial versus femoral access (79.2% versus 75.3%; P=0.1). There was also no difference in total diagnostic yield between the group without conversion and the conversion group (78.4% versus 82.6%; P=0.4); however, spasm was more prevalent in the conversion group (67.7% versus 79.4%; P=0.04). There were no differences in CFT complication rates between groups.
Conclusions:
Primary radial access with routine administration of calcium channel blockers was not associated with a lower diagnostic yield in CFT than primary femoral access. Procedural safety was comparable.
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