Patient Characteristics and Outcomes of Radial to Femoral Access-Site Crossover

Background

The need for radial to femoral access-site crossover (RFC) remains a limitation of radial percutaneous coronary intervention (PCI) with unknown implications.

Methods

The UC San Diego Health internal National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent PCI from January 2018 to September 2022 for any indication. Coronary artery bypass graft patients were excluded. Patient- and procedure-level predictors of RFC, complications, and all-cause mortality within 1-year post-PCI were assessed.

Results

A total of 3054 patients were included with a mean age of 67 ± 12 years, and 43.2% had acute coronary syndrome. Of these patients, 109 required RFC, 2287 had successful radial access (RA), and 658 had successful femoral access. There were no differences in comorbidities between the RFC and RA groups. Patients who required RFC had 29% longer fluoroscopy time and 16% more contrast volume compared to patients who had RA. Independent predictors of RFC were age >70 years (OR, 2.68; 95% CI, 1.79-4.01; P < .001), vasopressor support at the time of PCI (OR, 2.87; 95% CI 1.33-6.20; P = .007), and dialysis dependence (OR, 3.05; 95% CI, 1.34-6.93; P = .008). Patients who required RFC had higher 30-day all-cause mortality (3.7% vs 1.0%, P = .028), bleeding complications (8.3% vs 2.6%, P = .003), and need for blood products (7.3% vs 1.4%, P < .001) compared to patients who had RA. There was no difference in all-cause mortality or complications between the RFC and femoral access groups.

Conclusions

Radial to femoral access-site crossover was associated with higher short-term mortality and bleeding complications compared to RA. Age greater than 70 years, vasopressor support, and dialysis dependence were associated with RFC.