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Trends in the Prevalence and Outcomes of Radial and Femoral Approaches to Percutaneous Coronary Intervention

A Report From the National Cardiovascular Data Registry

Sunil V. Rao, MD, FACC^_*,_*, Fang-Shu Ou, MS^_*, Tracy Y. Wang, MD, MS^_*, Matthew T. Roe, MD, MHS, FACC^_*, Ralph Brindis, MD, MPH, FACC, John S. Rumsfeld, MD, PhD, FACC, Eric D. Peterson, MD, MPH, FACC^_*

^_* The Duke Clinical Research Institute, Durham, North Carolina
Division of Cardiology, Oakland Kaiser Hospital, Oakland, California
Denver VA Medical Center, Denver, Colorado.

^_* Reprint requests and correspondence: Dr. Sunil V. Rao, Durham VA Medical Center, 508 Fulton Street (111A), Durham, North Carolina 27705. (Email: sunil.rao{at}duke.edu).

Objectives: Our goal was to compare trends in the prevalence and outcomes of the radial and femoral approaches to percutaneous coronary intervention (PCI) in contemporary clinical practice.

Background: There are few current data on the use and outcomes of the radial approach to PCI (r-PCI) in clinical practice.

Methods: Data from 593,094 procedures in the National Cardiovascular Data Registry (606 sites; 2004 to 2007) were analyzed to evaluate trends in use and outcomes of r-PCI. Logistic regression was used to evaluate the adjusted association between r-PCI and procedural success, bleeding complications, and vascular complications. Outcomes in elderly patients, women, and patients with acute coronary syndrome were specifically examined.

Results: Although the proportion of r-PCI procedures has recently increased, it only accounts for 1.32% of total procedures (n = 7,804). Compared with the femoral approach, the use of r-PCI was associated with a similar rate of procedural success (adjusted odds ratio: 1.02 [95% confidence interval: 0.93 to 1.12]) but a significantly lower risk for bleeding complications (odds ratio: 0.42 [95% confidence interval: 0.31 to 0.56]) after multivariable adjustment. The reduction in bleeding complications was more pronounced among patients <75 years old, women, and patients undergoing PCI for acute coronary syndrome.

Conclusions: The use of r-PCI is rare in contemporary clinical practice, but it is associated with a rate of procedural success similar to the femoral approach and with lower rates of bleeding and vascular complications, even among high-risk groups. These results suggest that wider adoption of r-PCI in clinical practice may improve the safety of PCI.

Key Words: percutaneous coronary intervention • radial artery • outcomes

Abbreviations and Acronyms   ACC = American College of Cardiology   ACS = acute coronary syndrome   f-PCI = femoral approach to percutaneous coronary intervention   NCDR = National Cardiovascular Data Registry   NSTE ACS = non–ST-segment elevation acute coronary syndrome   PCI = percutaneous coronary intervention   r-PCI = radial approach to percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction