Effect of Virtual Reality on Anxiety, Pain, and Radial Artery Spasm During Transradial Coronary Angiography: A Prospective Randomized Controlled Trial

Background: Radial artery spasm (RAS) is a major complication of transradial coronary angiography (TRA) that adversely affects procedural success and patient comfort. Although procedural anxiety and pain contribute to RAS development, prospective randomized controlled data on the effect of virtual reality (VR) on RAS are limited. This study aimed to evaluate the effects of VR on anxiety, pain, and RAS during TRA. Methods: In this prospective, single-center, randomized controlled trial, 236 patients undergoing elective TRA were randomized 1:1 to the VR or control group. Following prespecified post-randomization exclusions, 130 patients (65 per group) were included in the per-protocol analysis. The intervention group received standardized VR content throughout the procedure. The primary endpoint was clinically assessed RAS; secondary endpoints included pre- and post-procedural state anxiety (STAI-S) and post-procedural pain measured using the visual analog scale (VAS). Results: Clinically assessed RAS occurred less frequently in the VR group than in the control group (7.7% vs. 52.3%, p < 0.001). Post-procedural STAI-S and VAS scores were also lower in the VR group (both p < 0.001). In an exploratory multivariable model, post-procedural STAI-S (OR, 1.29; 95% CI, 1.13–1.47; p < 0.001) and VAS scores (OR, 3.44; 95% CI, 1.98–5.98; p < 0.001) were associated with RAS. Because these variables were measured after the procedure, temporal direction and mediation cannot be inferred. Conclusions: In this single-center per-protocol analysis, VR use was associated with lower post-procedural anxiety and pain and a lower incidence of clinically assessed RAS during TRA. The large effect estimate should be interpreted cautiously because the intervention could not be blinded, the endpoint included subjective clinical features, and substantial post-randomization exclusions limit generalizability. Multicenter trials with blinded or objective endpoint corroboration and intention-to-treat analyses are warranted.