Temporal Trends in the Use of the Radial Approach in a Large Tertiary Center - More is Better

Background: The trans-radial approach (TRA) has been increasingly adopted for the use of percutaneous coronary interventions (PCI), with reported benefit in hospital stay length, and reduced bleeding events. We sought to examine the changing patterns of TRA and the effect on various outcomes

Methods: From an all comer large database of 21763 consecutive PCI`s we analyzed patients in 2 periods -2008 to 2012 (introduction of the TRA) and 2013 to 2017 (gain of popularity of TRA). We examined the proportions of use of TRA ,the influence on in hospital Hb and Creatinine change and the adjusted long term effect.

Results: the adoption rate of TRA rose from 20% (2% to 34% in various operators) in period 1 to 70% (25% to 87% in various operators) in period 2. Use in anticoagulated patients rose from 21.5% to 50.3%, in acute cases from 19.5% to 72%, in STEMI from 16.2% to 65.7%. the rate of TRA adoption for patients with CTO rose to 67% and for bifurcation treatment to 71.9%. in patients with renal failure the adoption rate rose to 56.2% and in unprotected LM PCI , to 49.5%. in both periods, there was a lower in-hospital hemoglobin decrease and also a lower creatinine increase post PCI (adjusted p<0.001). In multivariate analysis with adjustment for acyclic directed graph chosen confounders, use of the radial approach was associated with a lower long term rate of the composite of death, MI, TVR or CABG . in period 1 a Hazard ratio of 0.86 (95%CIֲ 0.77-0.96 p=0.007) and in period 2 a hazard ratio of 0.62(95%CI 0.55-0.7 p<0.0001).

Conclusions: the higher adoption rate of TRA for more complex patients seems to be associated with consistent short and long term benefits. More is probably better.