AJmer ULnar ARtery Working Group Study | Clinical Trial - AJULAR

Mar 15, 2015
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Presenter/Author:
Rajendra Kumar Gokhroo, MD
Author/Summarized by Author:
Dharam J. Kumbhani, MD, SM, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
03/15/2015
Original Posted Date:
03/15/2015
References

Description:

The goal of the trial was to compare outcomes after transradial vs. transulnar access in patients undergoing coronary angiography.

Contribution to the Literature: This study suggests that transulnar access may have similar vascular, crossover and spasm rates as transradial access in patients undergoing coronary angiography/intervention.


Study Design

Patients were randomized in a 1:1 fashion to either transradial (n = 1,262) or transulnar (n = 1,270) access. All operators had a minimum experience of 50 transulnar cannulations.

  • Total number of enrollees: 2,532

Inclusion criteria: Ulnar artery easily palpable and anatomy favorable

Exclusion criteria:

  • Inability to palpate either radial or ulnar artery
  • Primary angioplasty
  • Cardiogenic shock
  • Patients on chronic hemodialysis
  • Vasospastic disease (Raynaud’s disease)
  • Severe forearm skeletal deformities
  • Post–coronary artery bypass grafting (CABG)

Principal Findings:

The primary composite outcome, major adverse cardiac events (MACE) or major vascular events for transulnar vs. transradial access was: 14.6% vs. 14.4%, p = 0.92. MACE: 2.9% vs. 3.2%, p = 0.79; large hematoma: 1% vs. 0.9%.

Secondary outcomes were: Crossover: 4.4% vs. 3.8%, p = 0.44; vessel spasm: 6.9% vs. 8.7%, p = 0.1.

Interpretation:

The results of this trial indicate that transulnar catheterization is feasible and seems to have similar vascular, crossover, and spasm rates as transradial catheterization. Prior studies have shown that operator experience is key to successful completion, and indeed in this trial, all operators had performed a minimum of 50 transulnar cases before. Transulnar catheterization may be a viable nonfemoral access route for coronary angiography and interventions.

References:

Presented by Dr. Rajendra Gokhroo at ACC.15, San Diego, CA, March 15, 2015.

Keywords: ACC Annual Scientific Session, Angiography, Cardiac Catheterization, Hematoma, Hemoglobins, Patient Safety, Percutaneous Coronary Intervention, Prospective Studies


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