C-65 | Patient Characteristics and Outcomes of Radial to Femoral Access-Site Crossover

Need for radial to femoral access-site crossover (RFC) remains a limitation of radial percutaneous coronary intervention (PCI) with unknown implications. The UC San Diego Health National Cardiovascular Data Registry (NCDR) CathPCI Registry was used to obtain data on patients that underwent PCI from January 2018 to September 2022. Coronary artery bypass graft patients were excluded. Patient and procedure level predictors of RFC, complications, and all-cause mortality within 1 year post PCI were assessed. N=3,037 patients were included, mean age was 67 ± 12, 45% had acute coronary syndrome. N=140 had RFC, N=2,268 had successful radial access (RA), and N=629 had successful femoral access (FA). Patients with RFC had 35% longer fluoroscopy time and 17% more contrast volume compared to patients that did not require crossover. There was no difference in past medical history between groups. Independent predictors of RFC were age > 70 years (OR 1.79, 95% CI 1.27–2.52, P<0.001) and vasopressor support at time of PCI (OR 2.15, 95% CI 1.13–4.10, P=0.02). Patients with RFC had significantly higher all-cause mortality compared to patients with RA at 30 days (4.3% vs 0.9% P<0.001), 6 months (6.4% vs 2.4% P=0.004), and 1 year (7.9% vs 4% P=0.026) with higher complication rates (12.1% vs 5.3% P<0.001) driven by need for blood products (8.6% vs 1.4% P<0.001). There was no difference in all-cause mortality or complications between patients with RFC and FA. Age > 70 years and vasopressor support predicted radial to femoral access-site crossover, these patients may benefit from an initial femoral approach.