Gender Outcomes and Comparisons of Ultrasound Guided Ulnar vs. Radial Cardiac Catheterization and Percutaneous Coronary Intervention

Background
Ultrasound guidance provides anatomical visualization for precise vessel access. The use of ultrasound guidance in women vs. men undergoing ulnar or radial cardiac catheterization (CC) and percutaneous coronary intervention (PCI) has not been previously studied.

Methods
We performed an observational study of 96 patients [(58±10 years, median follow-up of 8 months, Interquartile Range (IQR 5, 11)] who underwent ultrasound guided ulnar or radial CC and PCI from October 2016 to July 2018. Groups were divided into females (n=38, 39.6%) or males (n=58, 60.4%) who underwent either ulnar (n=49, 51.0%) or radial access (n=47, 49.0%). Primary endpoints included death, myocardial infarction (MI), stroke, repeat revascularization, stent thrombosis, stent re-stenosis, and access site complications. Secondary endpoints included access success, number of access attempts, and conversion to an alternative site.

Results
In women (58±12 years) vs. men (58±9 years), none of the primary endpoints occurred in the ulnar or radial groups with successful access in all patients. No difference in access attempts was found in the radial or ulnar groups. However, men had greater access attempts [6 males (10.3%), 2 access attempts (1 radial and 5 ulnar)] compared with females (1 attempt only, p=0.041). Males had more conversions from radial to femoral access compared with ulnar access [7 (29.2%) vs 3 (8.8%); p=0.043). MI occurred in 60 patients (62.5%) with more non-ST elevation MI in males (n=35, 60.3%) compared with females (n=15, 39.5%, p=0.045). PCI was performed in 46 patients (47.9%), of which, 16 were women (34.8%) and 30 were men (65.2%, p=0.58). No difference was found between the number of PCIs in the ulnar (n=26) or radial group (n=20, p=0.41).

Conclusions
In women vs. men, ultrasound guided ulnar or radial CC showed no significant differences in any of the primary outcomes. Men who underwent radial access had increased conversion to femoral and more access attempts compared with women. Thus, ultrasound guided ulnar CC and PCI can be safely performed in women or men. It can serve as an alternative access site in unsuitable radial candidates and allow preservation of the radial artery for future use.