Background:
Ultrasound provides visualization for access. The gender outcomes of women versus men undergoing dorsal distal radial artery (DDRA), radial, or ulnar cardiac catheterization and percutaneous coronary intervention (PCI) using ultrasound guidance has not been previously evaluated.
Methods: We performed a prospective observational study of 233 patients (59±11 years, median follow-up of 13 months, Interquartile Range [IQR 6, 26]) who underwent ultrasound guided DDRA, radial, or ulnar catheterization and PCI at a university hospital between October 2016 to May 2020. Groups were divided into women (n=78, 33.5%) or men (n=155, 66.5%) who underwent DDRA (n=18, 7.8%), radial (n=117, 50.2%), or ulnar access (n=98, 42.1%). Primary endpoints included number of access attempts and conversion to alternative access. Secondary endpoints included death, acute myocardial infarction (AMI), repeat revascularization, stent thrombosis, stent re-stenosis, and access site complications.
Results:
Women (59±11 years) and men (58±12 years) did not show any difference in access attempts (p=0.705) or conversion to alternative access (p=0.291). In men, 4 mortalities (radial group) occurred (1 metastatic cancer, 1 suspected pulmonary embolism, 1 AMI who presented with cardiac arrest and cardiogenic shock, 1 lymphocytic myocarditis). None of the secondary endpoints or any complications occurred in women, DDRA, or ulnar access. AMI occurred in 137 patients (58.8%) with no gender difference (p=0.83) or gender difference in patients undergoing PCI (n=97, 75.2%; p=0.245).
Conclusions: Gender outcomes revealed that DDRA, ulnar, and radial had no significant difference in access attempts or conversion to alternative access. Women and men similarly underwent PCI for AMI. During the median 13-month follow-up, DDRA and ulnar cardiac catheterization and PCI showed safety and efficacy with no complications in women or men. Consequently, DDRA and ulnar can serve as alternative access so the standard radial artery can be used for future PCI or coronary artery bypass grafting.