Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach

Objectives: The aims of this study were to examine rates of radial artery access in post–coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach. Background: There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI. Methods: Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access. Results: The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG. Conclusions: The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

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Work Title Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach
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Open Access
Creators
  1. David A. Manly
  2. Wassef Karrowni
  3. Jennifer A. Rymer
  4. Lisa A. Kaltenbach
  5. Rajesh V. Swaminathan
  6. John C. Messenger
  7. J. Dawn Abbott
  8. Arnold Seto
  9. Carmelo Panetta
  10. Emmanouil Brilakis
  11. Ilias Nikolakopoulos
  12. Ian C. Gilchrist
  13. Prashant Kaul
  14. Habib Dakik
  15. Sunil V. Rao
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. JACC: Cardiovascular Interventions
Publication Date April 26, 2021
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.jcin.2021.01.053
Deposited November 16, 2021

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Version 1
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  • Created
  • Added 2021_JACCI_Radial_CABG.pdf
  • Added Creator David A. Manly
  • Added Creator Wassef Karrowni
  • Added Creator Jennifer A. Rymer
  • Added Creator Lisa A. Kaltenbach
  • Added Creator Rajesh V. Swaminathan
  • Added Creator John C. Messenger
  • Added Creator J. Dawn Abbott
  • Added Creator Arnold Seto
  • Added Creator Carmelo Panetta
  • Added Creator Emmanouil Brilakis
  • Added Creator Ilias Nikolakopoulos
  • Added Creator Ian C. Gilchrist
  • Added Creator Prashant Kaul
  • Added Creator Habib Dakik
  • Added Creator Sunil V. Rao
  • Published
  • Updated
  • Updated
  • Updated