Percutaneous coronary intervention via the radial artery: comparison of procedural success in emergency versus non-emergency cases

Background: STEMI and unstable acute coronary syndromes are associated with widespread adrenergic activation which may increase radial artery (RA) spasm, requiring cross-over to the femoral artery (FA) during percutaneous coronary intervention (PCI). We assessed the incidence of failed trans-radial artery PCI in emergency cases compared with non-emergency cases. Methods: PCI procedures performed by default radial artery operators were assessed in our centre over a 25month period. Those who had both RA and FA access were identified to assess if the double punctures were elective or due to failure of the RA approach. Cross-over rates were compared between emergency and nonemergency cases. Results: 680 cases of PCI were performed, 153 in an emergency setting. In non-emergency cases 403/527 (76.5%) were performed via the RA. In the emergency setting 139/153 (90.8%) were completed by the RA. Previous CABG with multiple arterial conduits was the most common reason for elective FA PCI in both groups. The RA to FA cross-over rate was low with no significant difference between the emergency and non-emergency groups (emergency 1.4%, non-emergency 1.2%, p=1.0). In both groups there was no significant difference between RA and FA procedures in terms of fluoroscopy times (emergency: mean 13.1 +/- 7.9min vs 16.1 +/- 16.1min, p=.25, non-emergency: 16.6 +/- 10.3min vs 18.7 +/- 13.6min, p=.07) or contrast volumes (emergency: mean 231 +/- 126 ml vs 229 +/- 102 ml, p=.77, non-emergency: 223 +/- 85 ml vs 237 +/- 91 ml, p=.15). Conclusions: The vast majority of PCI can be successfully performed via the RA. Cross-over rates to the FA are low and are not more common in emergency patients. (C) 2012 Elsevier Inc. All rights reserved.