title: Percutaneous coronary intervention via the radial artery: comparison of procedural success in emergency versus non-emergency cases.
abstract: BACKGROUND
  STEMI and unstable acute coronary syndromes are associated with widespread adrenergic activation which may increase radial artery (RA) spasm, requiring cross-over to the femoral artery (FA) during percutaneous coronary intervention (PCI). We assessed the incidence of failed trans-radial artery PCI in emergency cases compared with non-emergency cases.
  
  
  METHODS
  PCI procedures performed by default radial artery operators were assessed in our centre over a 25 month period. Those who had both RA and FA access were identified to assess if the double punctures were elective or due to failure of the RA approach. Cross-over rates were compared between emergency and non-emergency cases.
  
  
  RESULTS
  680 cases of PCI were performed, 153 in an emergency setting. In non-emergency cases 403/527 (76.5%) were performed via the RA. In the emergency setting 139/153 (90.8%) were completed by the RA. Previous CABG with multiple arterial conduits was the most common reason for elective FA PCI in both groups. The RA to FA cross-over rate was low with no significant difference between the emergency and non-emergency groups (emergency 1.4%, non-emergency 1.2%, p=1.0). In both groups there was no significant difference between RA and FA procedures in terms of fluoroscopy times (emergency: mean 13.1 ± 7.9 min vs 16.1 ± 16.1 min, p=.25, non-emergency: 16.6 ± 10.3 min vs 18.7 ± 13.6 min, p=.07) or contrast volumes (emergency: mean 231 ± 126 ml vs 229 ± 102 ml, p=.77, non-emergency: 223 ± 85 ml vs 237 ± 91 ml, p=.15).
  
  
  CONCLUSIONS
  The vast majority of PCI can be successfully performed via the RA. Cross-over rates to the FA are low and are not more common in emergency patients.
authors.affiliation: Department of Cardiology, Royal North Shore Hospital, Sydney, Australia. conleth_m@hotmail.com
authors.forename: John Conleth
authors.initials: JC
authors.lastname: Murphy
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kozor
authors.forename: Gemma A
authors.initials: GA
authors.lastname: Figtree
authors.forename: Michael R
authors.initials: MR
authors.lastname: Ward
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009517:New South Wales; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011677:Punctures; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure