title: A Comparison of Radial and Femoral Coronary Angiography in Patients From SNAPSHOT ACS, a Prospective Acute Coronary Syndrome Audit in Australia and New Zealand.
abstract: BACKGROUND
  There is wide variation in the use of radial over femoral access for patients with ACS. This study evaluates the factors associated with the selection of radial versus femoral angiography in Australia and New Zealand and the effect of access site on clinical events in acute coronary syndrome (ACS) patients.
  
  
  METHODS
  An analysis of the SNAPSHOT ACS audit was conducted during May 2012 across 286 hospitals in Australia and New Zealand. Data collected included baseline patient characteristics, hospital site details, treatment received, clinical events in-hospital and mortality at 18 months. Univariate and multivariable analyses were performed.
  
  
  RESULTS
  Of the 1621 patients undergoing coronary angiography, access was through the femoral artery in 1043 (63%), and the radial in 578 (36%) patients. Radial access dominated in New Zealand (241 out of 327, 73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with interstate variation (6% to 54%, p=<0.001). Independent predictors of access site included country of admission (Odds of radial, Aus v NZ OR 0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI 0.09-0.31, p=<0.0001), high GRACE score (90thdecile) (OR 0.44, 95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After adjustment, there was no difference in clinical events in-hospital or mortality at 18 months CONCLUSION: Coronary angiography in New Zealand rather than Australia is the strongest predictor of radial access in ACS patients. There was no difference in outcomes according to access site in this population based cohort study.
authors.affiliation: Concord Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Brooks
authors.affiliation: Department of Cardiology, Auckland City Hospital, Auckland, NZ.
authors.forename: Chris
authors.initials: C
authors.lastname: Ellis
authors.affiliation: Department of Medicine, University of Auckland, Auckland, NZ.
authors.forename: Greg
authors.initials: G
authors.lastname: Gamble
authors.affiliation: Cardiology, Waikato Hospital, Waikato, NZ.
authors.forename: Gerry
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Cardiology, Christchurch Hospital, Christchurch, NZ.
authors.forename: John
authors.initials: J
authors.lastname: Elliott
authors.affiliation: Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld., Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hammett
authors.affiliation: Cardiology, Department of Cardiovascular Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Chew
authors.affiliation: Coronary Care Unit, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: French
authors.affiliation: Cardiovascular Research Group, School of Population Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
authors.affiliation: Cardiovascular Division, The George Institute of Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rankin
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Karice
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Concordance Registry, Concord Hospital, Sydney, NSW, Australia.
authors.forename: Mario
authors.initials: M
authors.lastname: D'Souza
authors.affiliation: Coronary Care and Coronary Intervention, Department of Cardiology, Concord Hospital, Sydney, NSW, Australia. Electronic address: dbrieger@uni.sydney.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D001315:Australia; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D017534:Radial Artery
keywords: Acute coronary syndromes; Coronary angiography; Femoral access; Radial access