Anxiety score as a predictor of radial artery spasm during transradial approach for percutaneous coronary intervention

Abstract

Background: Transradial approach(TRA) is still not the dominant route used in for percutaneous coronary intervention(PCI). Radial artery spasm(RAS) is an important limitation of TRA failure and crossover to transfemoral approach(TFA). To enjoy the benefits of TRA, we need to predict the patients with high risk of spasm, to apply preventive measure in this specific subset of population. Objectives: The aim of the study was to assess the anxiety score as a predictive score of RAS in patients undergoing transradial percutaneous coronary intervention (TRA-PCI) Methods and material: The study population consisted of patients undergoing TRA-PCI by experienced TRA operators in our high volume radial center. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. preprocedural anxiety score was assessed and RAS was noted during procedure and post procedure. Logistic regression analysis was performed to determine independent predictors of RAS. ROC curve analysis was done to determine the cut-off value for anxiety score.
Results: A total of 360 consecutive patients undergoing TRA for PCI were included. The mean age of patients was 55.1 ±9.5 years, the majority (77.5%) were male. RAS was observed in 25.8%% patients. The rate of vasospasm was 19.4% for men and 48.1%% for women (P < .001). Mean anxiety score of the whole study population was 14.26±5.2. Anxiety score was 16.23±4.7 for women and 13.7+ 5.2 for men with statistical significance (P <0.01). Anxiety score was significantly increased in SPASM group (18.4±4.4) as compared to NO-SPASM group (12.8±4.6) (p<0.01) (odd’s ratio[OR]:1.26;95%confidence interval[CI]:1.18-1.33). After logistic regression analysis, female gender, more than mild anxiety score,>1 puncture attempts and glycoprotein IIb/IIIa platelet receptor(Gp2b3a) antagonist use emerged as independent predictors for RAS. ROC curve analysis revealed 80.5% area under the curve (p<0.01) with 87.1% sensitivity and 61.4% specificity to predict RAS when anxiety score is 13.5.
Conclusion: Anxiety score can be used to predict RAS during PCI. Using this score one can identify the high-risk subgroup, where intensive spasm preventive measures can lead to reduction in frequency of RAS. Additionally, female gender,>1 puncture attempts and
glycoprotein IIb/IIIa platelet receptor(Gp2b3a) antagonist use emerged as independent predictors for RAS. Although 25.8% RAS was noted in our study, TRA-PCI was successful in 99.1%.