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Título

Coronary angiography and interventions via distal transradial access in elderly as compared to non-elderly patients: insights from the DISTRACTION (DIStal TRAnsradial access as default for Coronary angiography and intervenTIONs) registry.

Resumo

Background: elderly patients are at higher risk of access site complications and bleeding. Systematic reviews and meta-analysis have highlighted the benefits of distal over proximal transradial access, mainly lower rates of radial artery occlusion and faster hemostasis. We aimed to evaluate the feasibility and safety of distal transradial access (dTRA) for routine coronary procedures in elderly patients, in comparison to non-elderly.

Methods: retrospective analysis of a large and real-world sample of 6,770 consecutive all-comers patients who underwent coronary angiography and/or percutaneous coronary interventions (PCI) via dTRA, included into the DISTRACTION (DIStal TRAnsradial access as default for Coronary angiography and intervenTIONs) registry, from February 2019 up to March 2024.

Results: in the elderly (≥65 years-old) group (n=3,222, 48%) there were more rates of hypertension (83% vs. 71.1%; p<0.0001), diabetes (45.1% vs. 34.7%; p<0.0001), previous stroke (2.9% vs. 2%; p=0.0425), chronic heart failure (9.2% vs. 7.1%; p=0.0040), severe aortic valvar disease (4.2% vs. 2.9%; p=0.0070), chronic kidney disease stages 3 and 4 (8.1% vs. 3.1%; p<0.0001), previous percutaneous coronary intervention (27.2% vs. 24.5%; p=0.0253), previous coronary artery bypass grafting (5.1% vs. 2.2%; p<0.0001), cardiogenic shock at presentation (1.3% vs. 0.4%; p=0.0003), rotational atherectomy (0.7% vs. 0.2%; p=0.0050), and left main PCI (2.7% vs. 1.5%; p=0.0033). There were no significant differences in the rates of access site crossovers. No major adverse cerebrovascular and cardiac events directly related to dTRA, no hand/thumb dysfunction or ischemia after any procedure, and no access site-related hematoma EASY ≥2 were recorded.

Conclusions: despite more comorbidities, more complex coronary disease and then more challenging presentation, the adoption of dTRA as default approach for routine coronary procedures in elderly patients, by proficient operators, appears to be safe and feasible.

Palavras Chave

elderly; distal transradial access; coronary procedures

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