Background: The practice of trans-radial artery (TRA) approach for coronary angiography and percutaneous coronary intervention (PCI) has been steadily increasing in the United States since 2007 from 1% to 16% in 2012. However, when compared to trans-femoral artery (TFA) approach the procedural efficacy for TRA was found to be worse in large studies. The aim of this study was to explore procedural efficacy of TRA vs TFA approach in a tertiary care teaching hospital.
Methods: We performed a retrospective review of data from 10,145 consecutive patients from our coronary catheterization lab database from 9/2011 to 5/2015 at University of South Dakota, Sanford Heart Hospital. Cases were analyzed for procedural efficacy as defined by duration of procedure, fluoroscopic time, and total contrast utilization.
Results: Overall, 7,581 (76%) patients underwent TRA approach and 2,564 (24%) patients underwent TFA approach. There was a shorter procedural duration for TRA approach vs TFR approach (60.1 minutes vs 78.3 minutes; p<0.0001), shorter fluoroscopic time for TRA approach vs TFR approach (6.06 minutes vs 9.01 minutes; p<0.0001), and less contrast utilization for TRA approach vs TFA approach (64.23 ml vs 72.15 ml; p<0.0001). The procedural duration trend over the past four years in quarterly increments is seen in Figure 1.
Conclusion: Contrary to what was seen in major trials; in our center, procedural efficacy was substantially better for TRA approach compared to TFA approach. Though procedural duration for TRA approach has remained the same over the past four years, there was also a general trend toward lengthening procedural duration for TFA approach.