Among patients undergoing diagnostic cardiac catheterization using transradial access, the use of prophylactic ipsilateral ulnar compression during radial artery hemostasis safely and effectively prevents radial artery occlusion, according to findings from the PROPHET-II study.
In the randomized study, researchers evaluated 3,000 patients referred for coronary angiography using transradial access at two large tertiary care centers. Patients were randomly assigned at a 1:1 ratio to patent hemostasis (group one; n = 1,497) or ulnar compression with patent hemostasis (group two; n = 1,503). All procedures were performed by five operators.
Samir B. Pancholy, MD, professor of medicine at The Commonwealth Medical College and program director of the fellowship in cardiovascular diseases at The Wright Center for Graduate Medical Education in Scranton, Pennsylvania, and colleagues used digital plethysmography to assess radial artery patency measured by the reverse Barbeau test.
Samir B. Pancholy
In patients where total loss of plethysmographic signal did not occur and in those in whom digital plethysmography detected radial artery occlusion, duplex ultrasonography was conducted to confirm patency status.
Patency was assessed upon removal of the radial compression band, 24 hours after the procedure and 30 days after the procedure. The primary endpoint was the 30-day rate of radial artery occlusion assessed by pulse plethysmography or oximetry.
According to the researchers, the two groups had similar baseline and procedural characteristics.
Differences in outcomes
The researchers found that group two had a lower rate of 30-day radial artery occlusion (0.9% vs. 3%; P = .0001) than group one. Group two also had lower rates of radial artery occlusion immediately after hemostasis (1.5% vs. 13.9%; P < .0001) and 24 hours after hemostasis (1% vs. 4.3%; P < .0001). Hematoma formation at the access site was not significantly different between groups.
Multivariable analysis revealed the following as significant independent predictors of 30-day radial artery occlusion: age (OR = 1.1; 95% CI, 1.03-1.09); female sex (OR = 4; 95% CI, 2.3-7.2); history of diabetes (OR = 4.1; 95% CI, 2.2-7.5); prophylactic ulnar compression or allocation to group two (OR = 0.3; 95% CI, 0.16-0.57); and pain during compression (OR = 3.9; 95% CI, 1-14.9).
In a second multivariable model, which entered patent hemostasis as an independent variable in addition to the aforementioned variables, the significance of age, prophylactic ulnar compression and pain during compression was lost, and the following retained significance as independent predictors of 30-day radial artery occlusion: diabetes (OR = 2.6; 95% CI, 1.3-4.9); female sex (OR = 3; 95% CI, 1.7-5.7) and patent hemostasis (OR = 0.006; 95% CI, 0.001-0.25).
In a related editorial, Ferdinand Kiemeneij, MD, PhD, and Gerard J.J. Boink, MD, PhD, both from the department of cardiology, Tergooi Hospital, Blaricum, the Netherlands, wrote that these findings will have important implications for prevention of radial artery occlusion after transradial access.
“The investigators are to be congratulated with achieving the lowest incidence of [radial artery occlusion] currently reported,” Kiemeneij and Boink wrote. “At present, there are no recommended strategies to restore radial artery patency after iatrogenic occlusion, making prophylaxis of [radial artery occlusion] essential.” – by Jennifer Byrne
Disclosure: Pancholy reports serving as a consultant for Terumo Medical Corp. and holding equity in VasoInnovations Inc. The other researchers, Boink and Kiemeneij report no relevant financial disclosures.