Elsevier

American Heart Journal

Volume 138, Issue 3, September 1999, Pages 430-436
American Heart Journal

Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison,☆☆,,★★

https://doi.org/10.1016/S0002-8703(99)70143-2Get rights and content

Abstract

Background Transradial access is a recently developed alternative for diagnostic cardiac catheterization. Its effects on quality of life after the procedure, patient preference, and cost are unknown. Methods and Results We performed a randomized single-center trial in which 99 patients underwent transfemoral and 101 underwent transradial diagnostic cardiac catheterization. Quality of life was measured with the SF-36 and visual analog scales at baseline, 1 day, and 1 week. Patients were examined at 1 day and at 1 week after for complications. Costs were measured prospectively. One patient in the femoral group and 2 in the radial group crossed over to the alternative access site. There were no major access site complications. One patient in the transfemoral group had a minor stroke. Transradial catheterization significantly reduced median length of stay (3.6 vs 10.4 hours, P < .0001). Over the first day after the procedure, measures of bodily pain, back pain, and walking ability favored the transradial group (P <.05 for all comparisons). Over the week after the procedure, changes in role limitations caused by physical health, bodily pain, and back pain favored the transradial group (P < .05 for all comparisons). There was a strong patient preference for transradial catheterization as well (P < .0001). Transradial catheterization led to significant reductions in bed, pharmacy, and total hospital costs ($2010 vs $2299, P < .0001). Conclusions Among patients undergoing diagnostic cardiac catheterization, transradial access leads to improved quality of life after the procedure, is strongly preferred by patients, and reduces hospital costs. (Am Heart J 1999;138:430-6.)

Section snippets

Patient population

All patients referred for diagnostic cardiac catheterization were screened for participation. Patients with palpable femoral and radial pulses and a normal Allen’s test were included. Patients were excluded for known or suspected vascular disease precluding access, unstable coronary symptoms, need for additional procedures during the same hospitalization, or if they were unable or unwilling to give informed consent. Patients were not excluded for age, sex, body size, or race. Written informed

Results

Between March 4, 1996, and February 6, 1997, 993 patients were screened for participation (Figure 1).

. Flow diagram depicting recruitment of patients. TRC , Transradial cardiac catheterization; TFC, transfemoral cardiac catheterization.

Of these, 896 (90%) had a normal Allen’s test. The most frequent causes for exclusion were unstable symptoms (384) and the planned use of additional procedures (103). The baseline characteristics of the 2 groups were well matched (Table I).

. Baseline

Discussion

Cardiac catheterization is most commonly performed through femoral arterial access. However, this method may result in significant vascular complications.12 To minimize these, bed rest is required after catheter removal. As a result of the bed rest, many patients have back pain, urinary retention, or constipation. These problems may be accentuated in the elderly and in patients with preexisting back pain or prostatic hypertrophy.

In contrast, catheterization through the radial artery has several

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From the Medical College of Ohio, Cardiology Division; and Harvard Medical School, Beth Israel–Deaconess Medical Center.

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Supported by a grant from Cordis Corporation. Dr Cohen was supported in part by a Clinician-Scientist Award from the American Heart Association.

Reprint requests: Christopher J. Cooper, MD, Medical College of Ohio, Cardiology Division, 3000 Arlington Ave, Toledo, OH 43699-0008.E-mail: [email protected]

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