For patients with a history of CABG undergoing diagnostic catheterization and/or PCI, transradial access may be more effective in improving clinical outcomes than the transfemoral approach, according to a study published April 19 in JACC: Cardiovascular Interventions.

David A. Manly, MD, FACC, et al., used ACC's CathPCI Registry to evaluate post-CABG patients undergoing cardiac catheterizations and PCI between July 1, 2009, and March 31, 2018. The researchers compared mortality, vascular complications, bleeding, and procedural metrics in transradial and transfemoral access. Temporal trends were examined for transradial access only.

Throughout the study, transradial access rates rose from 1.4% to 18.7%. The results showed that transradial access led to decreased bleeding, mortality and vascular complications. In addition, with transradial access, there was "significantly decreased contrast volume" among all procedure types and an increase in PCI procedural success rates. If an operator used the radial approach in non-CABG patients, they were more likely to perform radial access in post-CABG patients as well.

"Compared with femoral access, radial access in post-CABG patients was associated with increased fluoroscopy time for diagnostic procedures but decreased adverse clinical events," the authors conclude.

In a related editorial comment, David L. Fischman, MD, FACC, explains that the "study adds to the mounting evidence of the clinical benefits of the use of the radial artery for vascular access in the patient with prior CABG and should encourage the interventionalist to become proficient in going 'up in arms' in CABG patients requiring repeat coronary angiography and PCI to improve clinical outcomes."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: CathPCI Registry, National Cardiovascular Data Registries, Coronary Artery Bypass, Fluoroscopy, Registries, Hemorrhage, Cardiac Catheterization, Benchmarking, Percutaneous Coronary Intervention, Coronary Angiography, Radial Artery

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