Abstract 636: The Transition From Femoral-first to Radial-first Access Coronary Angiography/Percutaneous Coronary Intervention is Associated With a Decrease in Major Vascular Access Site Complications

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Background: Possible risks in coronary angiography/ percutaneous coronary intervention are vascular access site complications. In recent years access through the radial artery has been promoted as being associated with a lower incidence of major vascular access site complications (VASC). Methods/Results: We analyzed VASC for the years of 2013 to 2017 and in order to determine whether or not the increase in radial access during coronary angiography/percutaneous coronary intervention procedures in our cardiac catheterization laboratory was associated with a lower incidence of major VASC defined as hematoma larger or equal than 5 cm, bleeding with decrease in hemoglobin greater than 2 g/dL or requiring blood transfusion, arteriovenous fistula, pseudoaneurysm and radial artery thrombosis. The proportion of cases performed via radial access from 2013 (5.01%) to 2017 (88.22%), (slope = 22.25±1.872; p = 0.001) were initially analyzed and indicated a significant increase in the proportion of radial-first access over the time period in question. Following these results, the proportion of major VASC was analyzed and a linear regression run over the same 5 year period (slope = -0.2499±0.05905; p = 0.0241) consistent with a significant decrease in the incidence of major VASC over this time period. Over the same period of time the number of total VASC defined as major VASC plus hematoma smaller than 5 cm, any bleeding and pain at the arteriotomy site decreased from 2013 to 2017 but the decrease was not statistically significant. Conclusion: Over 5 years from 2013 to 2017, the proportion of procedures performed via radial access has increased significantly. This was accompanied by a significant downward trend in the number of major VASC, while the decrease in total VASC was not statistically significant.

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