Clinical predictors and management for radial artery spasm: An Australian cross sectional study

Introduction The transradial approach for coronary artery catheterisation has increased in popularity compared to the transfemoral approach for patients undergoing percutaneous coronary interventions. However, radial artery spasm continues to be a major complication of the procedure. Aim To identify the predictors of radial artery spasm and the medications used for its prevention and management. Methods A descriptive cross-sectional study was carried out across two tertiary hospitals in NSW, Australia. A self-administered pre-procedural survey was completed by patients undergoing coronary artery catheterisation. This survey collected socio-demographic data and assessed anxiety using the Spielberger State-Trait Anxiety Inventory. Procedural data, including length of procedure, equipment used, occurrence of radial artery spasm, and medications given, were collected post-procedure by the interventionalist. Results Of the 169 participants, over half were male (59.8%) and aged 66 years or older (56.8%). Radial artery spasm was reported in 24 (14.2%) participants. Rates of spasm were significantly higher among females (66.6%, p=0.004), those aged under 65 years (62.5%, p=0.001) and those who reported a medical history of anxiety (33.3%, p=0.0004). There were no significant differences in State and Trait anxiety scores among those who had RAS and those who did not. Logistic regression identified younger age as a statistically significant predictor of RAS (OR 0.536; 95% CI 0.171 to 1.684; p=0.005) To prevent radial artery spasm most patients received midazolam (n=158; 93.5%), nitrates (n=133; 78.7%) and/or fentanyl (n=124; 73.4%) prophylactically. Nitrates were the most frequently administered medication to treat radial artery spasm (78.7%). Conclusion This study found greater clarity around predictors for RAS is required, as identifying patients at risk can ensure prophylactic measures are implemented. This study identified nitrates as the preferred vasodilator as a preventative measure along with the use of sedation.