Impact of sex differences on the feasibility and safety of distal radial access for coronary procedures: a multicenter prospective observational study.

Background: Conventional transradial access in women is associated with a lower success rate and a higher incidence of spasm compared to men. To date, the effect of sex on the performance of distal radial access (DRA) has not been fully elucidated. The aim of this study was to assess the impact of sex on catheterization success and other performance parameters of DRA procedures.

Methods: This is a prospective three-center observational study. From August 2020 to September 2022, data from all consecutive patients who underwent DRA for coronary procedures were collected.

Results: A total of 868 procedures were registered and stratified into two groups according to sex: women (n = 258) and men (n = 610). Female patients had less favorable baseline characteristics than male patients in terms of absent or weak pulse (29% vs. 17%; P  < 0.001), distal radial diameter (2.2 ± 0.3 vs. 2.4 ± 0.4 mm; P  < 0.001) and proximal radial diameter (2.5 ± 0.7 vs. 2.7 ± 0.7 mm; P  = 0.001). No differences in success rates were found in women compared to men (94.2% vs. 96.6%; P  = 0.135), with a higher presence of arterial spasm in women (5.8% vs. 3.0%; P  = 0.044). The preprocedural ultrasound evaluation was the only predictor of DRA success [odds ratio = 20.0 (4.739-83.333); P  < 0.001].

Conclusion: In patients undergoing coronary procedures, the success rate of DRA was high regardless of sex, with a higher incidence of arterial spasm in women.