Why is this study important?   

Radial artery access for Percutaneous Coronary Intervention (PCI) is preferred over femoral artery access according to the 2021 ACC/AHA guidelines in patients with acute coronary syndrome and stable ischemic heart disease (Level of Evidence IA). As the United States has lagged behind many other countries with regard to adopting radial access as first line over the years, this study aimed to evaluate contemporary data on access site selection and associated outcomes.  

What question was this study supposed to answer?  

This retrospective cohort study from the National Cardiovascular Data Registry’s Cath PCI Registry and included data from PCIs performed in the U.S. between January 1, 2013, and June 30, 2022. The investigators evaluated rates of radial access and rates of complications. They used instrumental variable analysis to support causal inference (i.e., to associate access site choice with mortality, bleeding risk and major vascular complication risk). 

What did the study show?  

The study included data from 2,244,115 PCI procedures, 61.6% of which were performed via radial access, a 2.8-fold increase in the use of radial access in the U.S. compared to a decade earlier. The increase was most significant in ST-elevation myocardial infarction (MI). Through instrumental variable analysis, the investigators determined that the drastic increase in radial access was associated with a significant decrease in in-hospital mortality (absolute risk difference [ARD] -0.15%, p<0.001), major access site bleeding (ARD -0.64%, p<0.001), and major vascular complications (ARD -0.21%, p<0.001). However, radial access was associated with a slightly higher risk of ischemic stroke (ARD 0.05%, p<0.001).