Diabetes and Risk of Radial Artery Occlusion After Distal Radial Access: Insights From the KODRA Registry.

BACKGROUND

Distal radial access (DRA) is increasingly used for coronary angiography (CAG) and percutaneous coronary intervention, but evidence in patients with diabetes is limited. We investigated whether diabetes is associated with forearm radial artery occlusion (RAO) after DRA.

METHOD: From the multicentre KODRA registry (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach), 4,941 patients undergoing attempted DRA between September 2019 and September 2021 were analysed: diabetes (n=1,813) and non-diabetes (n=3,128). The primary efficacy end point was forearm RAO at 1 month. Secondary safety end points were DRA-related bleeding, other secondary end points included puncture success, access-site crossover, and successful CAG without crossover.

RESULTS

Despite a greater burden of comorbidities, patients with diabetes had similar rates of RAO compared with those without diabetes (0.5% vs 0.8%; p=0.139). DRA-related bleeding occurred in 3.0% vs 3.4% (p=0.535), with no major bleeding reported. Puncture success (94.1% vs 94.5%), overall access-site crossover (6.9% vs 6.6%), and successful CAG without crossover (98.9% vs 98.8%) were likewise comparable. In multivariable analysis, diabetes was not independently associated with RAO (odds ratio 0.585; 95% confidence interval 0.261-1.311; p=0.193) or other secondary end points.

CONCLUSIONS

In this large registry, DRA showed comparable RAO, bleeding, and procedural success between patients with and without diabetes. These results support DRA as a safe, feasible access strategy in this higher-risk population and highlight the need for standardised technique to preserve radial artery patency.