Prevention of Radial Artery Occlusion After Transradial Access Using Nitroglycerin - PATENS

Apr 03, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
04/02/2022
Date Published:
03/21/2022
Date Updated:
04/03/2022
Original Posted Date:
04/03/2022
References

Contribution To Literature:

The PATENS trial failed to show that intra-arterial nitroglycerin prevents radial artery occlusion after cardiac catheterization.

Description:

The goal of the trial was to evaluate intra-arterial nitroglycerin compared with placebo among patients undergoing cardiac catheterization via transradial access.

Study Design

  • Randomized
  • Parallel
  • Double-blind
  • Placebo-controlled

Patients undergoing cardiac catheterization via transradial access were randomized to nitroglycerin 500 mcg (n = 1,020) versus placebo (n = 1,020). A second randomization was to give study drug upon sheath insertion versus right before sheath removal.

  • Total number of enrollees: 2,040
  • Duration of follow-up: 30 days
  • Mean patient age: 62 years
  • Percentage female: 38%
  • Percentage with diabetes: 37%

Inclusion criteria:

  • Patient undergoing cardiac catheterization via transradial access

Other salient features/characteristics:

  • Mean number of catheter exchanges: 1.8
  • Radial artery occlusion occurred in 2.4% of patients

Principal Findings:

The co-primary outcome, radial artery occlusion at 24 hours, occurred in 2.5% of the early nitroglycerin group vs. 2.3% of the placebo group (p = 0.65).

The co-primary outcome, radial artery occlusion at 24 hours, occurred in 2.3% of the late nitroglycerin group vs. 2.5% of the placebo group (p = 0.65).

Secondary outcomes:

  • Radial artery occlusion at 30 days: 1.8% of the nitroglycerin group vs. 1.6% of the placebo group (p = 0.73)
  • Radial artery spasm: 10.8% of the nitroglycerin group vs. 13.4% of the placebo group (p = 0.06)
  • Hypotension: 2.5% of the nitroglycerin group vs. 1.2% of the placebo group (p = 0.03)

Interpretation:

Among patients undergoing cardiac catheterization via transradial access, intra-arterial nitroglycerin was not beneficial. Nitroglycerin failed to reduce radial artery occlusion at 24 hours whether given early or late after sheath insertion. Re-establishment of flow at 30 days occurred in 30.6% of those with early radial artery occlusion. While giving intra-arterial nitroglycerin for the purpose of preventing radial artery occlusion does not seem warranted, this medication remains a useful medication for some patients to treat or prevent radial artery spasm.

References:

da Silva RL, de Andrade PB, Dangas G, et al. Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin: PATENS Trial. JACC Cardiovasc Interv 2022;Mar 21:[Epub ahead of print].

Editorial Comment: Ghazzal Z, Chaabo O. Preserving the Golden Access: Importance of Best Practices. JACC Cardiovasc Interv 2022;Mar 21:[Epub ahead of print].

Presented by Dr. Roberto da Silva at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, April 2022.

Clinical Topics: Noninvasive Imaging, Prevention, Echocardiography/Ultrasound

Keywords: ACC22, ACC Annual Scientific Session, Cardiac Catheterization, Coronary Occlusion, Hypotension, Nitroglycerin, Radial Artery, Secondary Prevention, Spasm, Ultrasonography, Doppler, Pulsed, Vasodilator Agents


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