Incidence and determinants of non-radial vascular approach for coronary angiography among heart transplant recipients

Abstract

Abstract Background Repeated coronary angiograms may be required among heart transplant (HT) recipients to detect coronary allograft vasculopathy (CAV), exposing to higher risk of non-radial vascular approach over time. Objective To describe the incidence and determinants of non-radial vascular approach in this specific population in a large HT center. Methods Consecutive HT recipients undergoing coronary angiography between October 2020 to November 2022 at our Hospital, the largest French HT center, were included and all previous coronary angiograms performed after heart transplantation were retrospectively reviewed. A radial vascular approach has systematically been the first-line approach for coronary angiography in the last two decades. Coronary angiography is routinely performed one year after heart transplantation and every couple of years thereafter or more frequently in case of CAV progression or clinical indication. Determinants of non-radial vascular approach were assessed using multivariate logistic regression analyses, which included the individual mean number of coronary angiographies per year after heart transplantation to account for disparities in follow-up between the two groups. Results A total of 326 patients were included during the period of interest, with a median number of 4 (1-7) coronary angiographies performed over a median duration of 7.0 (1.8-13.1) years (Table 1). A non-radial approach was used in 108 (33.1%) patients, after a median delay from HT of 3.0 (1.0 - 8.4) years (Figure 1). Independent determinants of non-radial approach were female sex (Odds Ratio [OR] 2.18, 95% confidence interval [CI] 1.06 – 4.50), older age at the time of HT (OR 0.98 95%CI 0.96-0.99), post-transplantation dialysis (OR 7.34, 95%CI 2.41 – 22.30) and the development of type 3 CAV according to the International Society Heart and Lung Transplantation (ISHLT) classification (OR 2.01, 95%CI 1.20 – 3.35. Severe complications related to the vascular approach remained rare. Conclusions Non-radial vascular approach remains frequent among HT recipients. In a center of high HT volume and high radial access volume, non-radial vascular approach is used in one out of three HT recipients with multifactorial reasons.