Coronary Angiography Through the Wrist May Trump Access Through the Groin

A new study finds that operating through the radial artery in the wrist rather than the femoral artery in the groin when performing coronary angiography and other heart-related procedures is as effective and is less likely to result in bleeding complications. (Image: JAMA, ©AMA)

New Orleans—Although interventional cardiologists in the United States almost always operate through the femoral artery in the groin when performing coronary angiography and other heart-related procedures, research presented here at the scientific sessions of the American College of Cardiology may change that. A new study finds using the radial artery in the wrist as the access point for such procedures for patients with acute coronary syndromes is as effective and also has a reduced risk for bleeding complications.

The research findings, released simultaneously in The Lancet, involved 7021 patients from 158 hospitals in 32 countries who were randomly assigned to undergo either radial or femoral access for coronary angiography. The success of the procedure was similar for both groups. While the rates of death, myocardial infarction, or stroke at 30 days following the procedure also were similar for both groups, only 1.7% of those who had the procedure with radial access had a major vascular complication (such as a large hematoma or an injury to the artery near the access site that required surgical repair) compared with 3.7% of patients with femoral access.

Although it had been theorized that the reduced bleeding complications associated with radial access would decrease the risk of myocardial infarction, stroke, and death, that did not occur. About 90% of patients with radial access said they would prefer that method for a future intervention compared with less than half of those with femoral access saying they would prefer that method again.

The researchers found that patients at hospitals performing the most radial access angiographies fared better overall than those at institutions performing fewer procedures using radial access. “Both are very safe and effective,” said Sanjit Jolly, MD, an assistant professor of medicine at McMaster University in Hamilton, Ontario, Canada, who presented the study. “But we believe the more [radial procedures] you do, the better you get.”

Categories: Cardiovascular Disease/Myocardial Infarction, Cardiovascular Interventions, Cardiovascular System, Cardiovascular/Cardiothoracic Surgery