Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial

Jun-Won Lee; Yongcheol Kim; Bong-Ki Lee; Sang-Yong Yoo; Sang Yeub Lee; Chan Joon Kim; Han-Young Jin; Jin Sup Park; Jung Ho Heo; Do Hoi Kim; Jin Bae Lee; Dong-Kie Kim; Jun Ho Bae; Sung-Yun Lee; Seung-Hwan Lee

doi:10.1016/j.jcin.2023.11.021

Distal Radial Access for Coronary Procedures in a Large Prospective Multicenter Registry: The KODRA Trial

JACC Cardiovasc Interv. 2024 Feb 12;17(3):329-340. doi: 10.1016/j.jcin.2023.11.021.

Authors

Jun-Won Lee¹, Yongcheol Kim², Bong-Ki Lee³, Sang-Yong Yoo⁴, Sang Yeub Lee⁵, Chan Joon Kim⁶, Han-Young Jin⁷, Jin Sup Park⁸, Jung Ho Heo⁹, Do Hoi Kim¹⁰, Jin Bae Lee¹¹, Dong-Kie Kim¹², Jun Ho Bae¹³, Sung-Yun Lee¹⁴, Seung-Hwan Lee¹⁵

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
² Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital and Cardiovascular Center, Yonsei University College of Medicine, Yongin, South Korea.
³ Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.
⁴ Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea; Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, South Korea.
⁵ Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea; Division of Cardiology, Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
⁶ Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea.
⁷ Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
⁸ Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea.
⁹ Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea.
¹⁰ Division of Cardiology, Department of Internal Medicine, Hyundai Uvis Hospital, Incheon, South Korea; Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, South Korea.
¹¹ Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea.
¹² Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
¹³ Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea.
¹⁴ Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea; Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea.
¹⁵ Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea; Division of Cardiology, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, South Korea. Electronic address: carshlee@yonsei.ac.kr.

PMID: 38355261
DOI: 10.1016/j.jcin.2023.11.021

Abstract

Background: Distal radial access (DRA) as an alternative access route lacks evidence, despite its recent reputation.

Objectives: The aim of this study was to evaluate the safety and feasibility of DRA on the basis of daily practice.

Methods: The KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) trial was a prospective multicenter registry conducted at 14 hospitals between September 2019 and September 2021. The primary endpoints were the success rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI). The secondary endpoints included successful distal radial artery puncture, access-site crossover, access site-related complications, bleeding events, and predictors of puncture failure.

Results: A total of 4,977 among 5,712 screened patients were recruited after the exclusion of 735 patients. The primary endpoints, the success rates of CAG and PCI via DRA, were 100% and 98.8%, respectively, among successful punctures of the distal radial artery (94.4%). Access-site crossover occurred in 333 patients (6.7%). The rates of distal radial artery occlusion and radial artery occlusion by palpation were 0.8% (36 of 4,340) and 0.8% (33 of 4,340) at 1-month follow-up. DRA-related bleeding events were observed in 3.3% of patients, without serious hematoma. Multilevel logistic regression analysis identified weak pulse (OR: 9.994; 95% CI: 7.252-13.774) and DRA experience <100 cases (OR: 2.187; 95% CI: 1.383-3.456) as predictors of puncture failure.

Conclusions: In this large-scale prospective multicenter registry, DRA demonstrated high success rates of CAG and PCI, with a high rate of puncture success but low rates of distal radial artery occlusion, radial artery occlusion, bleeding events, and procedure-related complications. Weak pulse and DRA experience <100 cases were predictors of puncture failure. (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach [KODRA]; NCT04080700).

Keywords: anatomical snuffbox; coronary artery angiography; distal radial access; percutaneous coronary intervention.

Publication types

Multicenter Study

MeSH terms

Arterial Occlusive Diseases* / complications
Coronary Angiography / methods
Hemorrhage / etiology
Humans
Percutaneous Coronary Intervention* / adverse effects
Percutaneous Coronary Intervention* / methods
Radial Artery / diagnostic imaging
Registries
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04080700