Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry

Abstract

Background Women may benefit from radial artery access (RAA) for percutaneous coronary interventions (PCI) due to a higher risk of bleeding compared to men; however, RAA may be underutilized in women. We sought to determine the frequency and predictors of RAA use in patients undergoing PCI. Methods We studied 21,123 (29.0% female) participants in the Mayo Clinic PCI Registry from January 1, 2006–December 31, 2016. Data were analyzed as a cohort and by time tertiles. Frequency of RAA versus femoral access and bleeding events were recorded. Logistic regression was used to identify predictors of RAA. Results In the overall cohort, women compared to men were older (69.6 ± 12.6 vs. 65.6 ± 11.9; p < .001), more likely to present with acute coronary syndrome (82.0% in women vs. 80.0% in men; p = .0008) and had more comorbidities. RAA increased from tertile one (3.5% for women vs. 4.0% for men; p = .3) through tertile three (46.8% for women vs. 50.3% for men; p = .01), but remained lower in women. In multivariable analysis, female sex is associated with 22% less RAA use (OR 0.78, 95% CI 0.72–0.84; p < .0001). Women compared to men experienced more bleeding (6.3 vs. 3.0%; p < .0001) but bleeding was less likely in RAA (OR 0.45, 95% CI 0.36–0.56; p < .0001). Conclusion Women undergoing PCI are less likely to receive RAA compared to men despite having a higher risk of bleeding. This trend persists despite increase in RAA use. Given the potential benefit of RAA in women, sex should be considered in patient selection for RAA.

Sex Differences in Radial Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome Are Independent of Body Size

“…Our results are consistent with recently published United States registry data showing that female sex was an independent predictor of less radial artery access for PCI. Interestingly, in this study, when patient's height was added to the model, female sex was no longer predictive of access site choice [15].…”

Percutaneous Coronary Interventions in Women

“…A meta-analysis of four randomized controlled trials (MATRIX-ACCESS, RIVAL, SAFE-PCI, STEMI-RADIAL) showed in female patients undergoing coronary angiography or intervention, radial access is associated with decreased bleeding, MACCE, and vascular complications, suggesting that radial access should be the preferred approach for women [ 51 ]. Despite established improvement in vascular complication rate and bleeding with radial access, it remains underused in women [ 52 ], and there is higher rate of crossover (from radial to femoral) in women, likely due to smaller vessel size and tortuosity [ 53 ].…”

Barriers to use of radial access for percutaneous coronary intervention

“…Success in transradial access has multiple challenges such as vascular anatomic variants or vascular spasm and it is dependent on the operator's experience and skills. Therefore, transfemoral access is still commonly used while transradial access is underutilized especially in the United States . We retrospectively studied factors preventing radial access by single operator working in a trainee‐driven program whose default access route is the radial artery.…”