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

ABSTRACT Background. – Heart transplantation (HT) recipients undergo repeated coronary angiographies to screen for coronary allograft vasculopathy, which increases exposure to non-radial vascular access and potential related complications. Aims. – To describe the incidence and determinants of non-radial vascular approach among HT recipients in a large HT centre. Methods. – Consecutive HT recipients undergoing coronary angiography between October 2020 and March 2024 in the largest European HT centre were included, and all their previous coronary angiographies performed after HT were retrospectively reviewed. Determinants of non-radial vascular approach were assessed using multivariable logistic regression analyses, which included the individual mean number of coronary angiographies per year after HT to account for disparities in follow-up. Results. – A total of 429 patients (21.4% female, median [interquartile range] age at HT 50 [38–58] years) underwent a total of 1927 procedures, with a median number of 3 (1–7) coronary angiographies per patient performed over a median duration of 6.7 (1.3–12.9) years. The cumulative rate of non-radial vascular approach at 10 years was 35.5% (95% confidence interval 29.9–41.1%). Independent determinants of non-radial vascular approach were HT for ischaemic heart disease (adjusted odds ratio [aOR] 2.78, 95% confidence interval [CI] 1.69–4.54), multiple HT (aOR 5.71, 95% CI 1.42–23.01), female sex (aOR 2.22, 95% CI 1.18–4.16) and chronic dialysis after HT (aOR 3.19, 95% CI 1.09–9.28), but the number of procedures was not. Severe vascular complications were rare and not significantly different between vascular accesses. Conclusions. – In this high-volume centre, non-radial vascular approach was used in approximately one third of HT recipients during their follow-up, with multiple reasons, albeit not including the overall number of procedures performed.