Distal transradial coronary procedures in chronic versus acute coronary syndromes: insights from the DISTRACTION registry.

Abstract

Objectives: The benefits of distal (dTRA) over proximal transradial access (pTRA), mainly faster hemostasis and fewer radial artery occlusion, have been highlighted. Nevertheless, data addressing chronic vs acute coronary syndromes peculiarities are lacking; thus this study aimed to assess those differences.

Methods: The authors conducted a retrospective analysis of 6871 consecutive and all-comers patients from a real-world, large-scale registry of routine coronary angiography and/or percutaneous coronary intervention (PCI) via dTRA.

Results: Mean patient ages were 63.8 ± 15.7, 64.8 ± 15.7, and 62.9 ± 16 years for total, chronic, and acute coronary syndromes groups, respectively. In the chronic coronary syndromes group (n = 2,767, 40.3%) there was predominance of hypertension (83.5% vs 72.9%; P less than .001), diabetes (46.2% vs 37.4%; P less than .001), previous PCI (37.2% vs 20.2%; P less than .001) or coronary bypass surgery (4.9% vs 2.7%; P less than .001), previous ipsilateral pTRA (13.9% vs 8.5%; P less than .001) or dTRA (21.7% vs 8.9%; P less than 0.001) sheath insertion, and ultra-low contrast procedures (66.5% vs 61.2%; P less than .001). In the acute coronary syndromes group, there was predominance of male patients (66.9% vs 63.3%; P = .002), smokers (53.9% vs 45.6%; P less than .001), total amount of PCI (72.3% vs 48.5%; P less than .001), and right dTRA (85.3% vs 70.3%; P less than .001). No major adverse events directly related to dTRA were recorded.

Conclusions: When performed by proficient operators, routine coronary procedures via dTRA appear to be safe and feasible in both chronic and acute coronary syndromes, with similar low rates of access-site crossovers and complications.