Radial crossover and unsuccessful radial access during coronary angiography or percutaneous coronary intervention: insights from the FORCE-ACS registry

Abstract Background Radial crossover and unsuccessful radial access during coronary angiography or percutaneous coronary intervention (PCI) are associated with worse outcomes compared to successful radial access. The MATRIX score estimates the risk of radial crossover, but the predictive value of this novel risk score has not been evaluated in real-world acute coronary syndrome (ACS) patients. Purpose To evaluate (i) the temporal trends in the incidence for radial crossover and unsuccessful radial access, (ii) the reasons for unsuccessful radial access and (iii) the odds ratio for radial crossover and unsuccessful radial access in patients with a high MATRIX score. Methods Data from 4,514 ACS patients managed invasively and enrolled in the FORCE-ACS registry between January 2015 and December 2019 were used. Radial crossover was defined as a failure to either start or complete coronary angiography or PCI via radial access and subsequent crossover to femoral or brachial access. Unsuccessful radial access was defined as failure to complete the procedure via radial access and crossover to the femoral or brachial access. Reasons for unsuccessful radial access were: (i) issues during puncture or sheath insertion, (ii) failure to complete angiography and (iii) failure to complete PCI. The odds ratio for radial crossover and unsuccessful radial access of patients with a high MATRIX score (≥41) compared to patients with a low score (<41) was calculated using logistic regression. Results The observed rate of radial crossover was 20.7%. The radial crossover rate decreased throughout the years from 38.8% to 14.8% as shown in Figure 1A. The most common reasons for radial crossover was that the operator did not choose radial access as the initial access site and proceed directly to a femoral or brachial approach (18.3% of all procedures). If radial access was attempted but ultimately unsuccessful (2.9% of all radial access attempts), the most common reasons were failure to start or complete coronary angiography and issues with atrial puncture or sheath insertion (Figure 1B). Failure to complete PCI after successfully coronary angiography was rare. The rate of unsuccessful radial access relative to all radial access attempts was consistent over time between 1.8% and 4.2%. Patients with a high MATRIX score had a fourfold higher risk of radial crossover as compared to patients with a low score (odds ratio 4.07, 95%-CI: 3.47–4.78) and an almost twofold risk of unsuccessful radial access (odds ratio 1.87, 95%-CI: 1.19–2.93) (Figure 2). Conclusion The incidence of radial crossover declined throughout the years, while the rate of unsuccessful radial access was consistent over time. The MATRIX score is able to identify patients at higher risk of radial crossover and unsuccessful radial access. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The FORCE-ACS registry is supported by grants from ZonMw, the St. Antonius Research Fund and AstraZeneca.