Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial

Jun Won Lee, Yongcheol Kim, Bong Ki Lee, Sang Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Han Young Jin, Jin Sup Park, Jung Ho Heo, Do Hoi Kim, Jin Bae Lee, Dong Kie Kim, Jun Ho Bae, Sung Yun Lee, Seung Hwan Lee

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Background: Distal radial access (DRA) as an alternative access route lacks evidence, despite its recent reputation. Objectives: The aim of this study was to evaluate the safety and feasibility of DRA on the basis of daily practice. Methods: The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry conducted at 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access-site crossover, access site–related complications, bleeding events, and predictors of puncture failure. Results: A total of 4,977 among 5,712 screened patients were recruited after the exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA, were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access-site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion and radial artery occlusion by palpation were 0.8% (36 of 4,340) and 0.8% (33 of 4,340) at 1-month follow-up. DRA-related bleeding events were observed in 3.3% of patients, without serious hematoma. Multilevel logistic regression analysis identified weak pulse (OR: 9.994; 95% CI: 7.252-13.774) and DRA experience <100 cases (OR: 2.187; 95% CI: 1.383-3.456) as predictors of puncture failure. Conclusions: In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI, with a high rate of puncture success but low rates of distal radial artery occlusion, radial artery occlusion, bleeding events, and procedure-related complications. Weak pulse and DRA experience <100 cases were predictors of puncture failure.

Original languageEnglish
Pages (from-to)329-340
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume17
Issue number3
DOIs
Publication statusPublished - 2024 Feb 12

Bibliographical note

Publisher Copyright:
© 2024 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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