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

Background/Aims: 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.Methods: 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.Results: 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%, <i>p</i> = 0.094). DRA-related bleeding occurred more frequently in ACS (4.3% vs. 2.6%, <i>p</i> = 0.002). RAO rates were similar before discharge (0.1% vs. 0.2%, <i>p</i> = 0.396), but lower at one-month in ACS patients (0.3% vs. 1.0%, <i>p</i> = 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).Conclusions: 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.