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Temporal Trends and Predictors of Access Site Crossover During PCI in Contemporary Practice: A Report From the NCDR

Eli Reynolds1, Binita Shah2, Angel Marks3

  • 1Department of Internal Medicine (E.R.), New York University Langone Health.

Circulation. Cardiovascular Interventions
|July 20, 2026
PubMed

Insights

Vascular access site crossover during percutaneous coronary intervention (PCI) is common, especially with radial access. Operator experience significantly impacts crossover rates, with lower-volume operators experiencing more events, indicating a learning curve for radial access.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Access

Background:

  • Randomized trials report variable crossover rates between radial and femoral access during percutaneous coronary intervention (PCI).
  • Real-world contemporary crossover rates require further characterization.
  • Understanding these trends is crucial for optimizing patient outcomes and procedural efficiency.

Purpose of the Study:

  • To evaluate current trends in vascular access site crossover during PCI.
  • To identify clinical predictors associated with access site crossover.
  • To assess the impact of operator experience on crossover rates.

Main Methods:

  • Analysis of 3,861,790 index PCI procedures from the National Cardiovascular Data Registry CathPCI Registry (2018-2024).
  • Identification of access site crossover using documented access data, with radial-to-femoral crossover inferred.
  • Examination of temporal trends and clinical predictors, including operator experience based on PCI volumes.

Main Results:

  • 5.0% of PCIs involved access site crossover, showing a modest increase over time.
  • Radial-to-femoral crossover constituted 81.2% of all crossover events.
  • Older age, female sex, higher BMI, peripheral vascular disease, and lower operator PCI/radial PCI volume were associated with increased crossover.

Conclusions:

  • Contemporary real-world access site crossover rates align with randomized trial findings.
  • Lower-volume operators experience higher crossover rates, suggesting a learning curve for radial access.
  • Increasing operator experience correlates with improved procedural performance and reduced crossover rates.
Abstract

Keywords:
acute coronary syndromelearning curvepercutaneous coronary interventionradial arteryupper extremity

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