Upper Extremity Function following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trial

Abstract

Objectives. To determine the incidence of upper extremity dysfunction (UED), after a transradial percutaneous coronary intervention (TR-PCI). Background. Transradial approach (TRA) is the preferred approach for coronary interventions. However, upper extremity complications may be underreported. Methods. The ARCUS was designed as a prospective cohort study, including 502 consecutive patients admitted for PCI. Patients treated with transfemoral PCI (TF-PCI) acted as a control group. A composite score of physical examinations and questionnaires was used for determining UED. Clinical outcomes were monitored during six months of follow-up, with its primary endpoint at two weeks. Results. A total of 440 TR-PCI and 62 control patients were included. Complete case analysis (n = 330) at 2 weeks of follow-up showed that UED in the TR-PCI group was significantly higher than that in the TF-PCI group: 32.7% versus 13.9%, respectively ( p = 0.04 ). The three impaired variables most contributing to UED were impaired elbow extension, wrist flexion, and extension. Multivariate logistic regression showed that smokers were almost three times more likely to develop UED. Conclusions. This study demonstrates that UED seems to occur two times more in TR-PCI than in TF-PCI at 2 weeks of follow-up. However, no significant long-term difference or difference between the intervention arm and the contralateral arm was found at all timepoints.

Slender versus conventional approach reduces post‐procedural upper extremity dysfunction after transradial coronary procedures

“…Former literature showed an incidence varying from 1.7-75%. 3,5,20,21 With a power of 0.8, alpha of 0.05, an estimated incidence of 30% in the conventional group, and an estimated relative decrease of 30% in the slender group, a total group of at least 190 patients is required to achieve statistical significance for the primary endpoint. The following baseline characteristics have been recorded: age, sex, dominant hand, smoking status (where smoking is defined as current smoking or stopped ≤6 months before procedure), diabetes mellitus, hypertension, body mass index, use of beta blockers and statins, previous ipsilateral radial access, pre-procedural UED (QuickDASH), pre-procedural CI (CISS).…”

“…Our explanation is that, by the use of multiple and elaborated tests, and the lack of a MICD threshold, the incidence of postprocedural UED might have been previously overestimated beyond clinical relevance. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] By using QuickDASH, and setting MICD at 8, we knowingly chose for an easy and yet reliable tool. In our experience, and after correction for confounders, slender TRA procedures showed a lower incidence of early (2 weeks) post-procedural UED.…”