Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention: Procedural Efficiency, Radiation Exposure and In-Hospital Outcomes in a Real-World Single-Center Cohort

Background/Objectives: Transradial access (TRA) is the guideline-recommended default for coronary procedures, yet transfemoral access (TFA) remains common, and concerns persist that TRA prolongs procedures and increases radiation exposure. We compared procedural efficiency, radiation exposure and in-hospital outcomes between TRA and TFA in percutaneous coronary intervention (PCI). Methods: This single-center retrospective cohort study included consecutive patients who underwent PCI by five radial-experienced operators through a single access route. Procedure time and contrast volume (primary outcomes), and dose–area product (DAP) and air kerma (secondary outcomes) were compared using log-linear regression adjusted for pre-procedural covariates and by inverse probability of treatment weighting (IPTW). In-hospital major adverse cardiac and cerebrovascular events (MACCE) and major bleeding were exploratory outcomes. Results: Of 202 patients (mean age 61.9 ± 12.3 years; 24.3% women), 88 (43.6%) underwent TRA and 114 (56.4%) TFA; TFA was used in 71.3% of patients with ST-segment elevation myocardial infarction (STEMI). After adjustment, TRA was associated with 18% shorter procedure time (ratio of geometric means 0.82; 95% CI 0.71–0.95) and 16% less contrast (0.84; 0.73–0.95); IPTW and sensitivity analyses were directionally consistent. Air kerma (0.80; 0.64–1.01) and DAP (0.83; 0.67–1.03) were not significantly lower. In-hospital MACCE (5.7% vs. 6.1%; p = 0.891) and major bleeding (1.1% vs. 0.9%; p = 1.000) were infrequent. Conclusions: In this observational PCI cohort treated by radial-experienced operators, TRA was associated with shorter procedures and less contrast use than TFA. These associations, possibly reflecting access-site selection, do not establish causality; clinical events were too few to assess safety.