AHA: Radial bests femoral access for coronary angio; easy switch for cards

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Orlando, Fla.—A single-center real-world population trial comparing the radial access with femoral access has demonstrated the safety and efficacy of PCI with radial access for coronary angiography. Researchers noted that experienced invasive cardiologists can “easily and rapidly shift their practice towards radial access.” The results were presented Saturday at the late-breaking clinical science session at the 2009 American Heart Association conference.

“We show that an ad hoc switch from femoral to radial access as a routine strategy is not only feasible but goes along with the clear benefits for patient safety and comfort, and better use of human resources,” said lead researcher Tim G. Schaufele, MD, from MediClin Heart Center in Lahr, Germany.

In the prospective, randomized RAPTOR (Radial Access vs. conventional femoral PuncTure: Outcome and resource effectiveness in a daily Routine), 421 patients were admitted to one hospital for coronary angiography and randomly assigned to radial or femoral access. The results were reported on 410 evaluable patients.

For diagnostic procedures only, 152 patients went into both the femoral and radial access arms. For PCI, 55 patients underwent the femoral approach and 51 percent underwent the radial approach. In the radial arm, patients averaged two years younger at 64 years. Also, 12 patients had undergone CABG in the femoral arm and only five patients had undergone CABG in the radial arm.

Despite some of the differences, Schaufele reported access-route failure was the same for both groups, at 3.4 percent.

The RAPTOR researchers found similar results in overall duration of coronary angiography (8.4 minutes for radial access versus 10.9 minutes for femoral access); PCI times, with sheath exchange (23.4 vs. 25.1 minutes) or without (16.3 vs. 21 minutes); and quantity of contrast media (156.9ml vs. 148.7ml).

Overall, the researchers found that the radial approach saved 17.9 minutes for diagnostic procedure plus sheath removal and 47.2 minutes for diagnostics plus PCI plus sheath removal. As a result of these findings, Schaufele estimated that 3,000 procedures a year with 1,000 PCIs would equal 1,383 hours in reduce staff involvement.

He also noted that the total radiation time was shorter for femoral access, compared with radial access (4.4 vs. 6.4 minutes).

Among the panel commenting on the study, Patrick Serruys, MD, PhD, from the Thorax Center in Rotterdam, Netherlands, noted that the radial approach increases the operator exposure to radiation due to the longer duration of the procedure.

Another panelist, Alice K. Jacobs, MD, director of the cardiac cath lab and interventional cardiology at Boston University School of Medicine, said that most U.S. interventionalists do not use the radial approach, adding that it is only used “when we can’t use the femoral approach.”  She speculated that the radial access rates would increase.

“Several studies have reported decreased bleeding complications, hospital length and costs associated with radial in comparison to femoral artery access,” Jacobs said. “But to date, there has been no large-scale randomized trail evaluating the comparative effectiveness of radial versus femoral artery access in patients undergoing percutaneous cardiac procedures.”