Comparison of Long-Term Prognoses of Percutaneous Coronary Intervention via Distal Transradial and Conventional Transradial Access for Acute Coronary Syndrome

BACKGROUND Distal transradial access (dTRA) has recently emerged as a new vascular access alternative for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). However, published data on long-term mortality and major adverse cardiac events after PCI via dTRA are inconclusive. The aim of this study was to compare the long-term prognoses of PCI via dTRA and conventional transradial access (cTRA) for acute coronary syndrome (ACS) after 1-3 years of follow-up. METHODS Patients who were diagnosed with ACS and underwent PCI between January 1, 2020, and December 31, 2021, were retrospectively enrolled. The patients were divided into two groups at a 1:1 ratio, subjected to propensity score matching (PSM) and then followed for 1-3 years after PCI. Cox proportional hazards regression was used to evaluate the relationship between the two access sites and clinical outcomes. RESULTS Among the 550 patients in the dTRA and cTRA groups, 11 (4.0%) and 19 (6.9%) died during the observation period, respectively. dTRA and cTRA had similar risks of all-cause mortality [hazard ratio (HR) =0.688; 95% CI=0.323-1.463; P=0.331] and major adverse cardiac events (MACEs, HR=0.806, 95% CI= 0.515-1.263; P=0.347) after PCI. The risk of cardiovascular mortality (HR=0.330, 95% CI= 0.107-1.105; P=0.053), TLR-MACEs (HR= 0.587, 95% CI=0.339-1.109; P=0.058), and unplanned revascularization (HR= 0.860, 95% CI=0.483-1.529; P=0.606) were not significantly different between the two groups. CONCLUSIONS PCI via dTRA has the same long-term prognoses as PCI via cTRA in ACS patients, and the compression time and bleeding rate are lower than those in patients undergoing PCI via cTRA.