September 10, 2018
AHA Scientific Statement Supports Transradial Artery Access Procedures
September 10, 2018—Online in Circulation: Cardiovascular Interventions, Peter J. Mason, MD, et al published "An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association."
As summarized in the document, the purpose of this scientific statement is to propose and support a radial-first strategy in the United States for patients with acute coronary syndromes. The document also provides an update to previously published statements on transradial access (TRA) technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes (ACS).
Under leadership of Committee Chair, Dr. Mason, the document was drafted on behalf of the American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Peripheral Vascular Disease, and Council on Genomic and Precision Medicine.
In the statement, the investigators concluded that TRA should be considered the default strategy in the invasive management of patients with ACS. In the ACS population, TRA is associated with a significantly lower incidence of bleeding, vascular complications, and, potentially, mortality compared with transfemoral access (TFA).
The investigators stated that a mortality benefit is clearly observed in high-risk ACS (eg, ST-segment elevated myocardial infarction, cardiogenic shock) and in patients with high predicted bleeding risk. They advised that use of TRA in these patients requires operator and institutional experience to optimize procedural outcomes.
Compared with TFA, TRA is also associated with improved quality of life, reduced health care resource use, and reduced health care costs.
For these reasons and to facilitate adequate procedural expertise for high-risk patient subgroups, TRA should be considered the preferred access site strategy, advised the statement in Circulation: Cardiovascular Interventions.