Distal radial access in acute coronary syndrome patients with good arterial pulsation: a subgroup analysis from the KODRA registry.

Authors

Jun-Won Lee, Su Yong Kim, Jung Ho Heo, Han-Young Jin, Sung Woo Cho, Yongcheol Kim, Bong-Ki Lee, Sang-Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Jin Sup Park, Do Hoi Kim, Jin Bae Lee, Dong-Kie Kim, Jun Ho Bae, Sung-Yun Lee, Seung-Hwan Lee

Published in

The Korean journal of internal medicine. Volume 41. Issue 4. Pages 663-675. Epub Jul 01, 2026.

Abstract

Distal radial access (DRA) has been associated with fewer access-site complications, but evidence in acute coronary syndrome (ACS) remains limited. This study evaluated the feasibility and safety of DRA in ACS patients with good arterial pulsation.
Patients with good arterial pulsation from the prospective, multicenter KODRA registry were analyzed, comparing those with ACS (n = 1,618) and non-ACS (n = 2,588). The primary efficacy endpoint was successful coronary angiography (CAG) without access-site crossover. The primary safety endpoint was DRA-related bleeding, and the secondary safety endpoint was radial artery occlusion (RAO). Multivariable logistic regression was performed to assess the association between ACS and study endpoints.
The mean age was 66.3 ± 11.9 years, and 69.6% were male. The rate of successful CAG without access-site crossover was comparable between ACS and non-ACS patients (94.2% vs. 94.9%, p = 0.094). DRA-related bleeding occurred more frequently in ACS (4.3% vs. 2.6%, p = 0.002). RAO rates were similar before discharge (0.1% vs. 0.2%, p = 0.396), but lower at one-month in ACS patients (0.3% vs. 1.0%, p = 0.010). ACS was not independently associated with either primary efficacy (OR 0.871, 95% CI 0.664-1.144) or primary safety endpoint (OR 0.817, 95% CI 0.538-1.240).
In patients with good arterial pulsation, DRA was feasible in ACS, with higher bleeding but lower RAO compared with non-ACS. ACS was not independently associated with procedural failure or DRA-related bleeding. DRA may be considered a reasonable access strategy in selected ACS patients.

PMID:
42438907
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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