title: Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions.
abstract: OBJECTIVE
  To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  TRA-PCI failure has been reported in 5% to 10% of cases.
  
  
  METHODS
  TRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed.
  
  
  RESULTS
  From January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%.
  
  
  CONCLUSIONS
  In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure.
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brousseau-Provencher
authors.forename: Sarah
authors.initials: S
authors.lastname: Montminy
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.forename: Jimmy
authors.initials: J
authors.lastname: MacHaalany
authors.forename: Yoann
authors.initials: Y
authors.lastname: Bataille
authors.forename: Pierre
authors.initials: P
authors.lastname: Molin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Éric
authors.initials: É
authors.lastname: Larose
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Can M
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery; D061847:Hospitals, High-Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011792:Quebec; D017534:Radial Artery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000150:complications; D062606:Tertiary Care Centers; D017211:Treatment Failure
keywords: CABG; CI; OR; PCI; TFA; TIMI; TRA; Thrombolysis In Myocardial Infarction; confidence interval(s); coronary artery bypass graft; crossover; failure; odds ratio(s); percutaneous coronary intervention; percutaneous coronary intervention(s); radial artery; transfemoral approach; transradial access; transradial approach