Author + information
- Received July 21, 2015
- Accepted July 30, 2015
- Published online December 21, 2015.
- Lorenzo Azzalini, MD, PhD, MSc∗,
- Kunle Tosin, MD∗,
- Malorie Chabot-Blanchet, MSc†,
- Robert Avram, MD∗,
- Hung Q. Ly, MD, MSc∗,
- Benoit Gaudet, RN∗,
- Richard Gallo, MD∗,
- Serge Doucet, MD∗,
- Jean-François Tanguay, MD∗,
- Réda Ibrahim, MD∗,
- Jean C. Grégoire, MD∗,
- Jacques Crépeau, MD∗,
- Raoul Bonan, MD∗,
- Pierre de Guise, MD∗,
- Mohamed Nosair, MD∗,
- Jean-François Dorval, MD∗,
- Gilbert Gosselin, MD∗,
- Philippe L. L’Allier, MD∗,
- Marie-Claude Guertin, PhD†,
- Anita W. Asgar, MD∗ and
- E. Marc Jolicœur, MD, MSc, MHS∗∗ ()
- ∗Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
- †Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada
- ↵∗Reprint requests and correspondence:
Dr. E. Marc Jolicoeur, Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger Est, Montréal, Québec, H1T 1C8 Canada.
Objectives The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.
Background The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
Methods Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
Results A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
Conclusions In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
Dr. Azzalini was funded by a grant from the Spanish Society of Cardiology. Dr. Avram received a CCS Bayer Resident Award 2014. Dr. Ly receives funding from La Fondation de l’Institut de Cardiologie de Montréal and the Des Groseillers et Bérard Chair in Interventional Cardiology from Université de Montréal. Dr. Tanguay has received research grant support from Abbott Vascular, Ikeria, and GlaxoSmithKline; and has served as a consultant/speaker for AstraZeneca, Eli Lilly, Abbott Vascular, Actelion, and Bayer. Dr. Bonan has served as a consultant and received honoraria from Medtronic. Dr. L’Allier is supported by La Fondation de l’Institut de Cardiologie de Montréal; holds the Des Groseillers et Bérard Chair in Interventional Cardiology from Université de Montréal; has served as a consultant to Abbott Vascular and St. Jude Medical; has received institutional educational grants from Medtronic, Abbott Vascular, Eli Lilly, and AstraZeneca; and has received research grants from St. Jude Medical, Volcano/Philips, and AstraZeneca. Dr. Jolicoeur is supported by research grants from the Fonds de Recherche du Québec en Santé, The Canadian Institutes for Health Research (CIHR), and by La Fondation de l’Institut de Cardiologie de Montréal. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 21, 2015.
- Accepted July 30, 2015.
- American College of Cardiology Foundation