TY - JOUR
T1 - Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry
T2 - The KODRA Trial
AU - Lee, Jun Won
AU - Kim, Yongcheol
AU - Lee, Bong Ki
AU - Yoo, Sang Yong
AU - Lee, Sang Yeub
AU - Kim, Chan Joon
AU - Jin, Han Young
AU - Park, Jin Sup
AU - Heo, Jung Ho
AU - Kim, Do Hoi
AU - Lee, Jin Bae
AU - Kim, Dong Kie
AU - Bae, Jun Ho
AU - Lee, Sung Yun
AU - Lee, Seung Hwan
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/2/12
Y1 - 2024/2/12
N2 - 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.
AB - 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.
KW - anatomical snuffbox
KW - coronary artery angiography
KW - distal radial access
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2023.11.021
DO - 10.1016/j.jcin.2023.11.021
M3 - Article
C2 - 38355261
AN - SCOPUS:85184074404
SN - 1936-8798
VL - 17
SP - 329
EP - 340
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 3
ER -