BackgroundTransradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA.AimsTo assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).Material and MethodsAll 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the “intention‐to‐treat” access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded.ResultsThe STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, p < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, p < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (p = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, p < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes.ConclusionFemale sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.

中文翻译：

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ST段抬高型心肌梗死经桡动脉入路失败的性别差异


背景经桡动脉通路 (TRA) 现在是 PPCI 的默认通路部位，但从技术上讲，这是一种更具挑战性的方法，主要是由于与 RA 有关的解剖学挑战。目的评估初次经皮穿刺期间桡动脉 (RA) 通路部位特征的性别差异材料与方法对2011年3月至2017年12月期间来自我中心的连续5092例STEMI患者进行检查。右近端桡骨是所有患者的“意向治疗”通路。所有患者均进行术前 RA 血管造影。按性别分析临床和手术特征、桡骨解剖变异的类型、需要使​​用另一个动脉进入部位（本研究的主要终点）以及手术时间。使用逻辑回归，我们选择了径向交叉的预测因子。还记录了通路部位出血并发症和血管并发症。结果该时期的STEMI人群包括1326名女性和3766名男性患者。女性（65 ± 11 岁）比男性（59 ± 11 岁，p < 0.0001）大。在标准危险因素中，高血压和糖尿病在女性中更为常见，而吸烟则较少见。 RA 异常在女性中更为常见（8.8% vs. 6.5%，p < 0.0001），复杂的 RA 环和曲折的 RA 在女性中的发生率是女性的两倍。女性 STEMI 患者中 4.6% (61) 未能通过 TRA 作为最初选择的部位，而男性 STEMI 患者中这一比例为 2.5% (97) (p = 0.0003)。两组中最常见的后续接入部位是右尺骨接入（分别为 57% 和 61%）。进入部位出血并发症在女性中更为常见，分别为 4.4% 和 3.2%，这在 EASY 评分为 III 至 V 的血肿中也很常见。 临床 RA 痉挛 (RAS) 在女性中更为常见（5.7% vs. 2.2%，p < 0.0001）。多元回归分析确定了 TRA 通路交叉的 5 个独立预测因素：既往 TRA、异常 RA、RAS，以及女性和糖尿病。 结论女性是 STEMI 中更复杂 TRA 的重要预测因素。了解性别差异和 TRA 交叉的预测因素将加强不同手术方式的使用，从而有助于保持女性 STEMI 患者成功的手腕通路。