Diagnostic Coronary Angiography Access In Johannesburg

Abstract

Background: Contemporary interventional cardiology guidelines prefer radial over femoral artery access when performing diagnostic coronary angiograms (DCA). There is a paucity of data on the safety and efficacy of radial and femoral DCA in low-and-middle-income countries. Methods: We retrospectively reviewed inpatient medical records and DCA reports of patients referred for DCA and evaluated the safety and efficacy of the femoral versus radial artery access route. Results: There were 653 patients with a mean age of 58.2 ±12.6 years. Radial access was used in 318 (48.7%) patients. The median duration of the DCA was slightly longer with radial access and was 50 minutes (Interquartile range (IQR): 40–60), while the median procedural duration for femoral artery access was 45 minutes (IQR: 35–60) (P = 0.010). The median total radiation dose in the femoral artery access group was 3511 µGym2 (IQR: 2154–5821), and patients in the radial artery access group were exposed to a median radiation dose of 4011 µGym2 (IQR: 2298–6411) (P = 0.0661). A total of 639 (97.9%) DCA were performed without crossover, and 99.0% (95% CI: 97.2 – 99.8) of DCA performed via the radial artery did not require crossover to transfemoral access, and 96.1% (95% CI: 93.4 – 97.9) of the DCA done via the femoral artery did not require crossover to transradial access (P = 0.009). Conclusion: Almost half of all diagnostic angiograms were performed via the radial artery. Both radial and femoral artery access were equally safe and efficacious in patients with coronary artery disease.