title: Predictors of Access Site Crossover in Patients Who Underwent Transradial Coronary Angiography.
abstract: Despite increasing use of the transradial approach (TRA) for coronary angiography, TRA failure and subsequent access site crossover remain a barrier to TRA adoption. The aim of this study was to elucidate patient and procedural characteristics associated with TRA to transfemoral approach (TFA) crossover and examine TRA to TFA crossover by operator experience over time. This retrospective analysis identified 1,600 patients who underwent coronary angiography with possible percutaneous coronary intervention through TRA by operators with varied TRA experience in an urban tertiary care center from October 2010 to August 2013. Univariate and multivariable logistic regression were used to identify independent predictors of access site crossover, from TRA to TFA, and strength of association is presented as odds ratio (OR, 95% confidence interval [CI]). Access site crossover was noted in 166 patients (10.4%). Multivariable predictors of access site crossover included age >75 years (OR 1.90, 95% CI 1.23 to 2.91, p = 0.004) and operator experience (OR 2.98, 95% CI 1.96 to 4.52, p <0.0001). Less experienced operators (≤5 years TRA experience) had a decrease in access site crossover over time (quartile 1: 8.9%, quartile 2: 18.8%, quartile 3: 16.4%, and quartile 4: 8.6%, p <0.001), which paralleled an increase in the proportion of procedures using initial TRA over time (quartile 1: 38.0%, quartile 2: 53.7%, quartile 3: 54.8%, and quartile 4: 70.3%, p <0.001). Experienced operators (>5 years TRA experience) had no significant change in proportion of access site crossover over time (quartile 1: 2.8%, quartile 2: 6.4%, quartile 3: 5.6%, quartile 4: 5.8%, p = 0.54). In conclusion, rate of access site crossover in the contemporary era is relatively low and can be mitigated with operator experience.
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Le
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Sohah N
authors.initials: SN
authors.lastname: Iqbal
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Louis H
authors.initials: LH
authors.lastname: Miller
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Coppola
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D017534:Radial Artery; D012189:Retrospective Studies