Risk factors of radial artery occlusion following via transradial coronary catheterization

This study aimed to identify the independent risk factors associated with radial artery occlusion (RAO) after right transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI), and construct a visualized nomogram for individualized RAO risk prediction.

This single-center retrospective study enrolled 561 patients with suspected angina pectoris undergoing right transradial CAG/PCI from December 2023 to June 2024; all patients received a uniform 6F radial sheath. Radial artery patency was evaluated 24 h post-procedure via modified reverse Barbeau test (MRBT). Patients were divided into RAO group (n=49) and non-RAO group (n=512). Univariate logistic regression screened candidate variables (screen threshold p<0.1), and backward stepwise multivariate logistic regression was used to identify independent predictors. A nomogram was established based on regression coefficients of independent predictors. Model performance was assessed by ROC curve (AUC), calibration curve combined with Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA).

The overall incidence of RAO was 8.7%. Multivariable logistic regression identified four independent risk factors for RAO: prior coronary artery disease, multiple puncture attempts, puncture duration >15 min and radial arterial spasm. The AUC of the prediction model was 0.754 (95%CI 0.671-0.837). The calibration curve showed favorable consistency between predicted and actual RAO incidence, with HL test p=0.536. DCA verified reliable clinical net benefit of the nomogram for risk stratification.

Four independent predictors of post-transradial RAO were confirmed:prior coronary artery disease, multiple puncture attempts, puncture duration>15min and radial arterial spasm. The nomogram built on these four factors exhibited satisfactory discrimination, calibration and clinical utility. This tool can help clinicians screen high-risk patients and deliver targeted preventive interventions, while avoiding unnecessary prophylaxis for low-risk individuals. Further prospective external validation of this model is required.