Distal radial access in elderly patients aged 70 years and older for coronary procedures: Lessons from the KODRA registry.

Background: While distal radial access (DRA) is increasingly adopted for coronary procedures, evidence supporting its use in elderly patients remains limited. This study evaluated the feasibility and safety of DRA in elderly patients using data from the KODRA registry.

Methods: A total of 4941 patients were divided into elderly (≥70 years; n = 2091) and non-elderly (<70 years; n = 2850) groups. The efficacy endpoint was successful coronary angiography completion without access-site crossover, while the safety endpoint comprised a composite of DRA-related bleeding and access-site complications. Multivariable logistic regression analysis assessed associations between age ≥ 70 years and the efficacy and safety endpoints.

Results: The mean age was 77.5 ± 5.2 years in the elderly group. The cohort was 67.4 % male, with higher obesity rates and comorbidities in the elderly group. Puncture success was higher in the elderly (95.2 % vs. 93.8 %, p = 0.033), while the elderly experienced more frequent access-site crossover after successful puncture (1.6 % vs. 0.7 %, p = 0.002). The efficacy endpoint was comparable (93.5 % vs. 93.1 %, p = 0.496), whereas the safety endpoint occurred more frequently in the elderly (8.0 % vs. 6.1 %, p = 0.010). After adjustment for confounding variables, age ≥ 70 years was not associated with efficacy (odds ratio 1.054, 95 % confidence interval 0.831-1.337, p = 0.662) or safety endpoints (odds ratio 1.105, 95 % confidence interval 0.856-1.425, p = 0.445).

Conclusions: DRA in elderly patients aged ≥70 years revealed a comparable efficacy endpoint but a higher incidence of the composite outcome of DRA-related bleeding and access-site complications. Older age (≥70 years) itself was not significantly associated with either efficacy or safety endpoints.