Key result
Prophylactic nitroglycerin fails to reduce radial artery spasm compared to placebo during transradial catheterization.
Why the study?
Improved transradial access materials and operator expertise might mitigate the benefit of recommended prophylactic medications for radial artery spasm.
Does prophylactic nitroglycerin prevent radial artery spasm in patients undergoing transradial catheterization?
RCT (n=2,040)
randomized
Does prophylactic nitroglycerin prevent radial artery spasm in patients undergoing transradial catheterization?
Absolute Event Rate: 10.8% vs 13.4%
p-value: p=0.07
Prophylactic nitroglycerin during transradial catheterization does not significantly reduce radial artery spasm overall, but remains beneficial when procedures are performed by inexperienced operators.
One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 μg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.
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Silva et al. (2023) conducted an RCT in radial artery spasm during transradial catheterization (n=2,040). nitroglycerin vs. placebo was evaluated on radial artery spasm (RAS) (p=0.07). Prophylactic nitroglycerin did not significantly reduce radial artery spasm during transradial catheterization compared to placebo (10.8% vs. 13.4%, p=0.07).
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