Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry

JACC Cardiovasc Interv. 2008 Aug;1(4):379-86. doi: 10.1016/j.jcin.2008.05.007.


Objectives: Our goal was to compare trends in the prevalence and outcomes of the radial and femoral approaches to percutaneous coronary intervention (PCI) in contemporary clinical practice.

Background: There are few current data on the use and outcomes of the radial approach to PCI (r-PCI) in clinical practice.

Methods: Data from 593,094 procedures in the National Cardiovascular Data Registry (606 sites; 2004 to 2007) were analyzed to evaluate trends in use and outcomes of r-PCI. Logistic regression was used to evaluate the adjusted association between r-PCI and procedural success, bleeding complications, and vascular complications. Outcomes in elderly patients, women, and patients with acute coronary syndrome were specifically examined.

Results: Although the proportion of r-PCI procedures has recently increased, it only accounts for 1.32% of total procedures (n = 7,804). Compared with the femoral approach, the use of r-PCI was associated with a similar rate of procedural success (adjusted odds ratio: 1.02 [95% confidence interval: 0.93 to 1.12]) but a significantly lower risk for bleeding complications (odds ratio: 0.42 [95% confidence interval: 0.31 to 0.56]) after multivariable adjustment. The reduction in bleeding complications was more pronounced among patients <75 years old, women, and patients undergoing PCI for acute coronary syndrome.

Conclusions: The use of r-PCI is rare in contemporary clinical practice, but it is associated with a rate of procedural success similar to the femoral approach and with lower rates of bleeding and vascular complications, even among high-risk groups. These results suggest that wider adoption of r-PCI in clinical practice may improve the safety of PCI.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / therapy*
  • Age Distribution
  • Age Factors
  • Aged
  • Angina Pectoris / epidemiology
  • Angina Pectoris / therapy*
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / methods*
  • Angioplasty, Balloon, Coronary / statistics & numerical data*
  • Female
  • Femoral Artery*
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Prevalence
  • Radial Artery*
  • Registries
  • Risk Assessment
  • Sex Distribution
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology
  • Vascular Diseases / epidemiology
  • Vascular Diseases / etiology