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Título

Ultra-low contrast strategy for routine coronary angiography and interventions: insights from the DISTRACTION (DIStal TRAnsradial access as default for Coronary angiography and intervenTIONs) registry.

Resumo

Background: Contrast-related acute kidney injury (CR-AKI) is a common complication of coronary angiography (CAG) and/or percutaneous coronary intervention (PCI), especially in patients with advanced chronic kidney disease (CKD). Ultra-low contrast (ULC, total contrast volume ≤ patient’s estimated glomerular filtration rate [eGFR]) strategy is independently associated with lower risk of CR-AKI, as contrast amount plays a major role for such. Systematic reviews and meta-analysis have highlighted the benefits of distal (dTRA) over proximal (pTRA) transradial access, mainly lower rates of radial artery occlusion and faster hemostasis.

Methods: from February 2019 to March 2024, 6,770 consecutive all-comers patients submitted to CAG and/or PCI via dTRA have been enrolled into the DISTRACTION (DIStal TRAnsradial access as default for Coronary angiography and intervenTIONs) registry; out of them, 1,362 patients underwent ULC CAG/PCI, regardless of baseline eGFR or CKD.

Results: mean patient age was 64.5±21.4-years-old, most male (63.7%) and with acute coronary syndromes (56.1%). Overall, 355 (26.1%) patients had non-ST-elevation myocardial infarction, 266 (19.5%) had ST-elevation myocardial infarction, and 49 (3.6%) presented to the cath lab in cardiogenic shock status. There were only 42 (3.1%) access site crossovers, mainly (78.6%) performed via ipsilateral pTRA; thus, successful dTRA sheath insertion was obtained in 1,320 (96.9%) patients. Right dTRA was the most frequent access (76.2%), followed by redo right dTRA (15.9%), left dTRA (6%) and simultaneous bilateral dTRA (1.2%). In 804 (59%) of all patients, PCI was performed and left anterior descending was the most prevalent target coronary territory (29.2%). ULC CAG/PCI was successfully performed for all 1,362 patients: for 89,5% of them, total contrast volume was ≤25mL; for 71,5%, ≤20mL; for 49,1%, ≤15mL. No major adverse cardiac and cerebrovascular events and no major complications directly related to dTRA were recorded.

Conclusions: the implementation of the ULC strategy as default for routine coronary angiography and interventions via dTRA in a real-world fashion of all-comers patients, by experienced operators, appears to be feasible and safe.

Palavras Chave

ultra-low contrast; distal transradial access; coronary interventions

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