Radial-Access PCI on the Rise in the US

June 12, 2013

NEW YORK, New York — Radial-access PCI, which is already performed frequently in Canada, Europe, and Asia, appears to be taking off in the US, according to a new analysis [1]. The proportion of radial-PCI procedures increased from 1.2% in 2007 to 16.1% in 2013, with radial PCI accounting for 6.3% of all procedures in the CathPCI registry during this five-year period, report investigators.

The increased prevalence of radial-access PCI was not uniform across the country, however. The use of radial PCI increased over time more in the Northeast states than it did in the Western, Midwestern, and Southern US regions, with radial-access PCI accounting for 24% of all procedures in the Northeast. Approximately 13% of all hospitals included in the CathPCI registry did not perform any transradial PCIs.

"This analysis of the largest contemporary multicenter PCI registry shows that there has been a 13-fold increase in [radial-PCI] adoption over six years in US clinical practice," say Dr Dmitriy Feldman (Weill Cornell Medical College, New York) and colleagues in their report, published online June 10, 2013 in Circulation. "In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates while maintaining procedural success."

Radial Patients Younger, Fatter, and Male

Nearly 2.8 million procedures from 1381 hospitals were analyzed. Of these, 178 643 procedures were performed via the radial artery. Compared with transfemoral procedures, patients undergoing radial PCI were more likely to be younger, male, and have a higher body-mass index. The radial-PCI patients were also healthier than those undergoing conventional PCI, with patients less likely to have renal insufficiency, peripheral vascular disease, prior MI, congestive heart failure, or prior CABG surgery.

The researchers say that while radial PCI is increasing, it is still underused in groups at high risk for bleeding, such as older patients, women, and patients with an acute coronary syndrome. "However, its continued preferential use in younger patients, men, and those with lower-risk clinical features presents an opportunity to possibly improve overall PCI safety by increasing its application to higher-risk patients," write Feldman and colleagues.

Overall, procedural success rates with femoral- and radial-access PCI were similar, but vascular and bleeding complications were significantly lower in the radial-PCI group.

Outcomes With Radial- and Femoral-Access PCI

Outcome Radial PCI Femoral PCI p
Procedural success (%) 94.7 93.8 NS
Vascular complications (%) 0.16 0.45 <0.01
Bleeding complications (%) 2.67 6.08 <0.01
Fluoroscopy times (min) 14.2 11.1 <0.01

Compared with interventionalists in other countries, the slow adoption of radial-access PCI by US physicians might stem from concerns about how long it would take to become efficient at the procedure and the potential for lower procedural success rates with such inexperience. In addition, the need to cross over to the femoral artery for complex coronary lesions and worries about longer fluoroscopy might also represent a potential barrier to physicians learning the technique, the authors suggest.

In the present analysis, fluoroscopy times were longer, but as experience with radial access grows, "fluoroscopy times approaching those of [femoral-access] PCI could be strived for in the future," according to Feldman et al.

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