Characteristics and outcomes of patients with history of CABG undergoing cardiac catheterization via the radial versus femoral approach

Selected in JACC: Cardiovascular Interventions by S. Brugaletta

The aims of this study were to examine clinical and procedural outcomes in post-CABG patients who underwent diagnostic catheterization and/or PCI via the radial or femoral approach.

Reviewer

Salvatore Brugaletta

@sbrugaletta

Interventional cardiologist / Cardiologist

Barcelona, Spain

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My Comment

Why this study? – the rationale/objective

There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI.

The aims of this study were to examine clinical and procedural outcomes in post-CABG patients who underwent diagnostic catheterization and/or PCI via the radial or femoral approach.

How was it executed? – the methodology

Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009 to March 31, 2018 (n = 1,279,058 patients, 1,173 sites) were evaluated.

Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access.

What is the main result?

The rate of transradial access increased from 1.4 % to 18.7 % over the study period.

Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83 ; 95 % confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57 ; 95 % CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38 ; 95 % CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11 ; 95 % CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types.

Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only.

Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG.

Source: JACC: Cardiovascular Interventions

Source: JACC: Cardiovascular Interventions

Critical reading and the relevance for clinical practice:

It is well known that radial access is more comfortable for the patient and it is also associated with reduced bleeding rate and mortality, especially in ACS patients.

This present study analyzes a very common situation in our daily life, which is the catheterization of CABG patients. In these patients, considering the presence of left internal mammary artery, left radial access is usually performed, but there are no data comparing such access vs. femoral approach.

Over a period of 9 years, an increase of transradial access is seen, together with a decreased mortality, bleeding, vascular complications as compared to femoral access. It is surprising to see in 2018 less than 18.7 % of radial procedure in these patients and reasons for this are not well explained.

Of note also the fact that an increase in PCI procedural success is seen with radial vs. femoral access: this may be explained by learning curve, not only in making this access, but also in making PCI over the 9 years of the study, as those operators with higher rate of radial access are likely those with more experience as compared to operators who use femoral access.

In your practice, how often do you use radial access in CABG patients?