Study Shows Increase in Radial Access for PCI in United States

June 10, 2013—The American Heart Association (AHA) announced that a study showing an increased use of radial artery access for percutaneous coronary interventions (PCI) in the United States was published by Dmitriy N. Feldman, MD, et al in Circulation (2013;127:2295–2306).

According the AHA, the study investigators examined data of almost 3 million artery-opening procedures in 1,381 centers in 2007 to 2012. They found that in 2004 to 2007, doctors used the radial artery to reach the heart in less than one out of every 50 PCI procedures. By the study's end in 2012, nearly one out of every six PCIs was performed through a radial artery in the wrist—a 13-fold increase. The study investigators advised that wider use of the wrist-route procedure, particularly in high-risk patients, could improve PCI safety.

The investigators reported that bleeding complications occurred in 2.67% of the radial artery procedures, compared to 6.08% of the femoral artery procedures. There were also fewer vascular complications in the radial artery group versus the femoral group (0.16% vs 0.45%). High-risk patients—those older than 75 years, women, and people with acute coronary syndromes—benefited most from radial PCI. However, its use and growth of use is lowest in those patients, investigators noted. A “learning curve” is important in developing proficiency in radial PCI procedures, particularly in high-risk patients, stated Dr. Feldman, the study's lead investigator.

“Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe,” commented Dr. Feldman in the AHA press release. Dr. Feldman is Assistant Professor of Medicine at Weill Cornell Medical College, New York Presbyterian Hospital Department of Medicine, Greenberg Division of Cardiology in New York, New York.

Dr. Feldman noted that the radial artery is smaller and located closer to the skin's surface compared to the femoral artery, which is why it is easier to compress manually. This makes it easier to prevent or stop internal and external bleeding, which is an important concern in PCI because patients are often treated with blood-thinning medications.