Predictive Score of Radial Artery Spasm in Patients Undergoing Transradial Percutaneous Coronary Intervention

Background: In high-risk patients, such as those with acute coronary syndromes, transradial access has become the method of choice for coronary angiography and percutaneous coronary interventions (PCI) owing to better outcomes, shorter hospital stays, and fewer vascular problems. Aim: To predict the factors that may produce radial artery spasm, consequences, and the way to select the patients before PCI to minimize arterial access-related complications and avoid access site crossover. Methods: Using transradial access, this prospective study examined 300 patients having percutaneous coronary intervention (PCI). Two groups of patients were formed: The 60 patients in Group I (Spasm group) had radial artery spasms (RAS), while the 240 patients in Group Ⅱ (No spasm group) did not. Results: Female sex, height, body mass index(BMI), hypertension(HTN), peripheral artery disease (PAD), smoking, and radial artery diameter (RAD) can be used as independent factors for predicting radial artery spasm. The total possible score is 9, as female sex, height<170cm, BMI<25kg/m2, HTN and smoking each was assigned 1 point, while PAD and pre-PCI RAD<2.5mm was assigned 2 points. On conducting receiver operation curve(ROC) analysis to determine the optimal cutoff value to discriminate patients with radial artery spasm from patients without spasm, the analysis showed that the assigned risk score had the highest sensitivity (70%) and specificity (64.17%) at 4, with an area under the curve of 0.727. Conclusions: Patients with RAS showed a lower ankle brachial index, as well as an increased risk of complications such as femoral access crossover, prolonged procedure times, hematomas, and radial artery occlusion. A risk score developed through logistic regression, with a maximum score of 9 and a cutoff of 4, effectively predicts RAS with reasonable sensitivity and specificity.