Study of 10-Year CathPCI Registry Data Compares Radial Access to Femoral Access for PCI

May 2, 2024—In a retrospective cohort study, radial arterial access for percutaneous coronary interventions (PCIs) was shown to be superior to femoral arterial access with lower rates of in-hospital mortality, major access bleeding, and other major vascular complications.

The data, which was from the National Cardiovascular Data Registry’s CathPCI Registry, included PCIs performed between 2013 and 2022. The comparative safety of radial versus femoral access for PCI was evaluated using instrumental variable analysis exploiting operator variation in access preferences.

Reza Fazel, MD, cardiologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts, led the study. The late-breaking results were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2024 Scientific Sessions.

As summarized in the SCAI press release, 6,658,479 PCI procedures were performed during the study period. Of these, 40.4% (n = 2,690,355) were performed via radial access, increasing from 20.3% in 2013 to 57.5% in 2022, representing a 2.8-fold increase during the past decade. This increase was seen in all geographic regions and across the full spectrum of presentations, with the largest relative increase seen in patients with ST-segment elevation myocardial infarction.

The investigators reported that 2,244,115 PCIs met the inclusion criteria for the instrumental variable analysis. The analysis showed radial access was associated with lower in-hospital mortality (absolute risk difference [ARD], -0.15%; P < .001), major access site bleeding (ARD, -0.64%; P < .001), and other major vascular complications (ARD, -0.21%; P < .001) but a higher risk of ischemic stroke (ARD, 0.05%; P < .001). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (P = .89).

“The study demonstrates a sea change in the manner in which PCI is performed in the United States in response to trial data but also highlights the continued opportunity for practice improvement with dramatic interoperator variation,” commented Dr. Fazel in the SCAI press release. “It confirms that the benefit observed for radial access in randomized controlled trials has also been seen in real-world practice, including the largest benefits for the highest-risk patients. Finally, it shows a highly credible novel finding in the increased in stroke risk.”