Impact of obesity on palpation-guided distal radial access for coronary procedures: subgroup analysis of the multicenter, prospective KODRA registry.

Background: There is limited data on the impact of body mass index (BMI) on distal radial access (DRA). Using a large-scale prospective registry, the influence of obesity on DRA outcomes was evaluated, including cannulation and complications.

Methods: Using data from the prospective, multicenter KODRA (Korean Prospective Registry for Evaluation the Safety and Efficacy of Distal Radial Approach) registry data, 4,638 patients who planned palpation-guided distal radial artery puncture were enrolled into two groups, both with body mass index (BMI) information available: obese (n = 2,205; BMI ≥ 25 kg/m²) and non-obese (n = 2,433). The primary endpoint was the success rate of distal radial artery cannulation. Secondary endpoints included cannulation time, crossover rate, and DRA-related complications.

Results: The mean age was 66.6 ± 11.7 years and 67.2% were men. No significant difference existed in the success rate of distal radial artery cannulation between the two groups (94.5% in the obese group vs. 94.3% in the non-obese group, p = 0.787). This tendency in cannulation success rate and cannulation time was consistently observed in multiple sensitivity analyses, including multivariable and propensity score-matched analyses. Crossover rate (6.6% vs. 6.7%, p = 0.962) and DRA-related complications (4.3% vs. 4.6%, p = 0.630) were not significantly different between groups. However, cannulation time was significantly longer in the obese group compared to the non-obese group [105 (64-180) sec vs. 100 (60-155) sec, p = 0.002].

Conclusions: In this subgroup analysis of the KODRA trial, obesity was not associated with the success rate for palpation-guided distal radial artery cannulation, crossover rate, and DRA-related complications.