Sex Specificities of Patients Undergoing Coronary Procedures and Experiencing Transradial Approach Failures

OBJECTIVES: Failed transradial approach (TRA) in patients undergoing percutaneous coronary procedures is associated with higher rates of vascular complications. While female sex is associated with an increased risk of failed TRA, it is unknown if females are also exposed to an increased risk of adverse events after access crossover. The authors compared the outcomes of males and females experiencing crossover following a failed TRA. METHODS: The REPEAT study prospectively enrolled patients undergoing coronary procedures through TRA with access failure. In this subanalysis, patients were stratified according to sex. Propensity score matching for major confounders was used to generate comparable groups. The primary outcome was a composite of vascular complication and significant bleeding. RESULTS: Of 462 patients experiencing TRA failure, 245 were male and 217 female. Female patients were older and showed fewer comorbidities. TRA failure was more commonly related to radial tortuosity in females and subclavian tortuosity in males. After propensity score matching, 123 pairs were selected. Females showed higher rates of femoral crossover compared with males, in whom a contralateral radial access is mostly preferred. The incidence of the primary outcome was comparable between the 2 groups (males: 8.1% vs females: 12.2%; odds ratio [OR], 1.57; 95% CI, 0.68-3.64; P = .294). Consistent results were evident in a sensitivity analysis on patients undergoing cross over to femoral access (males: 14.5% vs females: 13.0%; OR, 0.8; 8 95% CI, 0.33-2.33; P = .805). CONCLUSIONS: In patients experiencing a failed TRA, no statistically significant differences were evident in terms of vascular complications or bleeding between females and males.