Yonsei Med J.  2017 May;58(3):521-526. 10.3349/ymj.2017.58.3.521.

Comparison of Clinical Outcomes between the Right and Left Radial Artery Approaches from the Korean Transradial Coronary Intervention Registry

• Park JY
• Rha SW
• Choi BG
• Oh DJ
• Choi CU
• Youn YJ
• Yoon J

• KMID: 2419108
• DOI: http://doi.org/10.3349/ymj.2017.58.3.521

Abstract

PURPOSE
Transradial intervention (TRI) shows anatomical and technical differences between the right radial approach (RRA) and left radial approach (LRA). The aim of this study was to evaluate the efficacy and safety using LRA, compared with RRA.
MATERIALS AND METHODS
A total of 1653 consecutive patients who underwent TRI from November 2004 to October 2010 were enrolled in the Korean multicenter TRI registry. The patients were divided into two groups: the RRA group (n=792 patients) and the LRA group (n=861 patients). To adjust for any potential confounders, propensity score matched (PSM) analysis was performed (C-statistic: 0.726). After PSM, a total of 1100 patients were enrolled for analysis.
RESULTS
After PSM, the RRA group exhibited a larger contrast volume (259.3±119.6 mL vs. 227.0±90.7 mL, p<0.001), a longer fluoroscopic time (22.5±28.0 minutes vs. 17.1±12.6 minutes) and higher access site change (12.3% vs. 1.0%, p<0.001) than the LRA group. Meanwhile, the LRA group showed a shorter procedure time (49.2±30.4 minutes vs. 55.4±28.7 minutes, p=0.003) than the RRA group. After PSM, in-hospital complications and 12-month cumulative clinical outcomes were similar between the two groups.
CONCLUSION
Of the two TRI methods, LRA was associated with better procedural efficacy, including shorter procedural time, smaller contrast volume, and less access site change than RRA. However, both methods showed similar 12-month cumulative clinical outcomes. Therefore, LRA was deemed superior to RRA in terms of procedural feasibility without a significant difference in clinical outcomes.

Keyword

Percutaneous coronary intervention; radial artery; treatment outcome

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/adverse effects/*methods/mortality
Female
Fluoroscopy
Humans
Male
Middle Aged
Myocardial Infarction/mortality/*therapy
Percutaneous Coronary Intervention/*methods
*Radial Artery
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome

Reference

1. Doyle BJ, Rihal CS, Gastineau DA, Holmes DR Jr. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol. 2009; 53:2019–2027.

2. Spaulding C, Lefèvre T, Funck F, Thébault B, Chauveau M, Ben Hamda K, et al. Left radial approach for coronary angiography: results of a prospective study. Cathet Cardiovasc Diagn. 1996; 39:365–370.

3. Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, et al. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J. 2008; 29:63–70.

4. Won H, Her AY, Kim BK, Kim YH, Shin DH, Kim JS, et al. Percutaneous coronary intervention is more beneficial than optimal medical therapy in elderly patients with angina pectoris. Yonsei Med J. 2016; 57:382–387.

5. Choi YJ, Kim JB, Cho SJ, Cho J, Sohn J, Cho SK, et al. Changes in the practice of coronary revascularization between 2006 and 2010 in the Republic of Korea. Yonsei Med J. 2015; 56:895–903.

6. Shin JS, Tahk SJ, Yang HM, Yoon MH, Choi SY, Choi BJ, et al. Impact of female gender on bleeding complications after transradial coronary intervention (from the Korean Transradial Coronary Intervention registry). Am J Cardiol. 2014; 113:2002–2006.

7. Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377:1409–1420.

8. Effects of recombinant hirudin (lepirudin) compared with heparin on death, myocardial infarction, refractory angina, and revascularisation procedures in patients with acute myocardial ischaemia without ST elevation: a randomised trial. Organisation to Assess Strategies for Ischemic Syndromes (OASIS-2) Investigators. Lancet. 1999; 353:429–438.

9. Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008; 1:379–386.

10. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009; 157:132–140.

11. Sciahbasi A, Romagnoli E, Trani C, Burzotta F, Pendenza G, Tommasino A, et al. Evaluation of the “learning curve” for left and right radial approach during percutaneous coronary procedures. Am J Cardiol. 2011; 108:185–188.

12. Kim SM, Kim DK, Kim DI, Kim DS, Joo SJ, Lee JW. Novel diagnostic catheter specifically designed for both coronary arteries via the right transradial approach. A prospective, randomized trial of Tiger II vs. Judkins catheters. Int J Cardiovasc Imaging. 2006; 22:295–303.

13. Jurga J, Nyman J, Tornvall P, Mannila MN, Svenarud P, van der Linden J, et al. Cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial access. Stroke. 2011; 42:1475–1477.

14. Lund C, Nes RB, Ugelstad TP, Due-Tønnessen P, Andersen R, Hol PK, et al. Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J. 2005; 26:1269–1275.

15. Fuchs S, Stabile E, Kinnaird TD, Mintz GS, Gruberg L, Canos DA, et al. Stroke complicating percutaneous coronary interventions: incidence, predictors, and prognostic implications. Circulation. 2002; 106:86–91.

16. Weintraub WS, Mahoney EM, Ghazzal ZM, King SB 3rd, Culler SD, Morris DC, et al. Trends in outcome and costs of coronary intervention in the 1990s. Am J Cardiol. 2001; 88:497–503.

17. Batchelor WB, Anstrom KJ, Muhlbaier LH, Grosswald R, Weintraub WS, O'Neill WW, et al. Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. National Cardiovascular Network Collaboration. J Am Coll Cardiol. 2000; 36:723–730.