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63 Comparing the safety & efficacy of radial versus femoral arterial access in chronic total occlusion percutaneous coronary intervention
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  1. Lloyd Tudor1,
  2. Abdul Mozid2
  1. 1Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, WYK LS1 3EX, United Kingdom
  2. 2Leeds Teaching Hospitals NHS Trust

Abstract

Background The radial arteries have increasingly become the primary choice for arterial access in percutaneous coronary intervention (PCI), surpassing the use of the femoral arteries due to a reduction in access site complication, reduction in mortality, and the avoidance of major bleeding. Despite this, there remains a lack of support for the routine adaptation of radial artery access in PCI for chronic total occlusion (CTOPCI).

Methods Patients undergoing CTOPCI between January 2015 and January 2022 at a single tertiary cardiology centre were classified according to arterial access method, gender, age, previous MI status, previous PCI status, previous CABG status, operator determined procedural success, incidence and type of complication, length of inpatient stay, and in-hospital mortality. Statistical analysis was performed via Jamovi software using predominantly Pearson’s chi-square tests, with two sample t-tests for comparing means and binomial logistic regression for identifying predictors of procedural success, incidence of complication, and in-hospital mortality.

Results A total of 638 cases were included for analysis in this study. The mean age of patients in this study was 66±11 years, 82.9% of patients were male, with no significant difference between either group. A chi-square test found those who had previously undergone PCI were more likely to require femoral access (χ2(1) = 11.6, p = <.001).

The mean length of an inpatient stay was 1.1±4 days, with no significant difference between length of stay in either group, t(636) = -1.13, p= 0.261. A chi-square test found that a procedure was more likely to be successful if radial access was utilised (χ2(1) = 5.6, p = 0.018). A chi-square test found that those in the femoral group were more likely to experience procedural complication (χ2(1) = 3.9, p = 0.048). Chi-square tests for complication types found those in the femoral group were more likely to experience a retroperitoneal bleed (χ2(1) = 6.7, p = 0.010).

Binomial logistic regression was performed to determine the effect of the measured variables on procedural success, incidence of complication, and in-hospital mortality. Procedural success was significantly associated with age (OR 1.04, 95% CI[1.02 - 1.06], p =<0.001), and with radial access (OR 1.75, 95% CI [1.15 - 2.67], p = 0.010). There were no significant associations between the variables and incidence of complication or in-hospital mortality.[Table 1][Table 2]

Abstract 63 Table 1

Conclusions This data shows that CTOPCI performed purely via the radial arteries is safer than via the femoral arteries, with a significant difference in complication as well as a significant difference in procedural success. Existing literature is encouraging for the use of at least one radial access site in CTOPCI and this study offers valuable information on the viability of a purely radial approach to CTOPCI and strengthens the existing evidence base for its more routine adoption.

Conflict of Interest Nil

  • radial artery
  • chronic total occlusion
  • percutaneous coronary intervention

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