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Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventions

Payam Dehghani, MD^_*, Atif Mohammad, MD^_*, Ravi Bajaj, BSc^_*, Tony Hong, BSc^_*, Colin M. Suen, BSc^_*, Waseem Sharieff, MD, Robert J. Chisholm, MD^_*, Michael J.B. Kutryk, MD, PhD, Neil P. Fam, MD, MSc^_*, Asim N. Cheema, MD, PhD^_*,_*

^_* Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

^_* Reprint requests and correspondence: Dr. Asim N. Cheema, Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada (Email: cheemaa{at}smh.toronto.on.ca).

Objectives: The study aimed to determine the mechanism and predictors of procedural failure in patients undergoing percutaneous coronary intervention (PCI) from the transradial approach (TR).

Background: Transradial approach PCI reduces vascular complications compared with a transfemoral approach (TF). However, the mechanism and predictors of TR-PCI failure have not been well-characterized.

Methods: The study population consisted of patients undergoing TR-PCI by low-to-intermediate volume operators with traditional TF guide catheters. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. Univariate and multivariate analyses were performed to determine independent predictors of TR-PCI failure.

Results: A total of 2,100 patients underwent TR-PCI and represented 38% of PCI volume. Mean age was 64 ± 12 years, and 17% were female. Vascular complications occurred in 22 (1%), and TR-PCI failure was observed in 98 (4.7%) patients. The mechanism of TR-PCI failure included inability to advance guide catheter to ascending aorta in 50 (51%), inadequate guide catheter support in 35 (36%), and unsuccessful radial artery puncture in 13 (13%) patients. The PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF. On multivariate analysis, age >75 years (odds ratio [OR]: 3.86; 95% confidence interval [CI]: 2.33 to 6.40, p = 0.0006), prior coronary artery bypass graft surgery (OR: 7.47; 95% CI: 3.45 to 16.19, p = 0.0002), and height (OR: 0.97; 95% CI: 0.95 to 0.99, p = 0.02) were independent predictors of TR-PCI failure.

Conclusions: Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI.

Key Words: coronary intervention • radial artery • vascular access

Abbreviations and Acronyms   BMI = body mass index   CABG = coronary artery bypass graft surgery   CI = confidence interval   LCA = left coronary artery   OR = odds ratio   PCI = percutaneous coronary intervention   RCA = right coronary artery   TF = transfemoral approach   TIMI = Thrombolysis In Myocardial Infarction   TR = transradial approach

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