Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection

Pietro Di Santo; Paul W Boland; Omar Abdel-Razek; Trevor Simard; Richard G Jung; Simon Parlow; Pouya Motazedian; Joanne Joseph; Pascal Theriault-Lauzier; Ali Alomar; Ali Hillani; Saad Alhassani; Mohamed Bayoumi Ali; Kwadwo Kyeremanteng; Doug Coyle; Dean Fergusson; George A Wells; Michael Froeschl; Marino Labinaz; Juan J Russo; Benjamin Hibbert

doi:10.1016/j.jscai.2023.100606

Association Between the Access Site for Coronary Angiography and Catheter-induced Coronary Artery Dissection

J Soc Cardiovasc Angiogr Interv. 2023 Mar 4;2(3):100606. doi: 10.1016/j.jscai.2023.100606. eCollection 2023 May-Jun.

Authors

Pietro Di Santo^{1

2

3}, Paul W Boland⁴, Omar Abdel-Razek^{1

2}, Trevor Simard^{5

6}, Richard G Jung^{1

6}, Simon Parlow^{1

2}, Pouya Motazedian^{1

2}, Joanne Joseph^{1

2}, Pascal Theriault-Lauzier¹, Ali Alomar¹, Ali Hillani¹, Saad Alhassani¹, Mohamed Bayoumi Ali¹, Kwadwo Kyeremanteng^{2

7}, Doug Coyle^{2

3}, Dean Fergusson^{3

8}, George A Wells^{2

9}, Michael Froeschl^{1

2}, Marino Labinaz^{1

2}, Juan J Russo^{1

2}, Benjamin Hibbert^{1

2

5}

Affiliations

¹ CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
² Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Division of Cardiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
⁵ Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota.
⁶ Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁸ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁹ Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Abstract

Background: Catheter-induced coronary artery dissection (CICAD) is a rare complication of coronary angiography. The association between access site and CICAD remains unclear; however, transradial access (TRA) may be associated with a higher incidence of CICAD due to access vessel tortuosity and the mechanical disadvantage of catheters designed for the transfemoral access (TFA) approach.

Methods: In this retrospective study, the reports of consecutive left heart catheterizations between April 2007, and December 2021 were reviewed for CICAD. Patients were excluded if the procedural report did not report an arterial access site. Identified CICAD cases were reviewed in detail.

Results: There were 142/89,876 (0.16%) identified cases of CICAD. The access site was not associated with an increased risk of CICAD (0.18% with TRA vs 0.15% with TFA; relative risk [RR], 1.18; 95% CI, 0.84-1.65; P = .34) over the entire study period. With respect to TRA-related CICAD, male sex was associated with a decreased risk of dissection (RR, 0.64; 95% CI, 0.41-0.99; P = .04), but ST-elevation myocardial infarction at presentation was associated with an increased risk (RR, 3.01; 95% CI, 1.86-4.85; P < .01). In the TFA-predominant era, TRA was associated with an increased risk of CICAD (0.48% TRA vs 0.11% TFA; RR, 3.42; 95% CI, 2.05-5.69; P < .01)-an association that was not present in the TRA-predominant era. In-hospital mortality in patients with CICAD was 8.5%.

Conclusions: CICAD is a rare complication of coronary angiography. Over a 15-year period, we did not demonstrate an association between access site and an increased risk of CICAD. There is substantial mortality associated with CICAD.

Keywords: catheter-induced coronary artery dissection; coronary angiography; percutaneous coronary intervention; transfemoral approach; transradial approach.