Distal radial access in acute coronary syndrome patients with good arterial pulsation: a subgroup analysis from the KODRA registry

Lee, Jun-Won; Kim, Su Yong; Heo, Jung Ho; Jin, Han-Young; Cho, Sung Woo; Kim, Yongcheol; Lee, Bong-Ki; Yoo, Sang-Yong; Lee, Sang Yeub; Kim, Chan Joon; Park, Jin Sup; Kim, Do Hoi; Lee, Jin Bae; Kim, Dong-Kie; Bae, Jun Ho; Lee, Sung-Yun; Lee, Seung-Hwan

doi:2026.41.4.663

Korean J Intern Med > Volume 41(4); 2026 > Article

ORIGINAL ARTICLE

Cardiology

Korean J Intern Med. 2026;41(4):663-675. doi: https://doi.org/10.3904/kjim.2025.349

Distal radial access in acute coronary syndrome patients with good arterial pulsation: a subgroup analysis from the KODRA registry

Jun-Won Lee¹, Su Yong Kim¹, Jung Ho Heo², Han-Young Jin³, Sung Woo Cho⁴, Yongcheol Kim⁵, Bong-Ki Lee⁶, Sang-Yong Yoo⁷, Sang Yeub Lee⁸, Chan Joon Kim⁹, Jin Sup Park¹⁰, Do Hoi Kim¹¹, Jin Bae Lee¹², Dong-Kie Kim¹³, Jun Ho Bae¹⁴, Sung-Yun Lee¹⁵, and Seung-Hwan Lee¹⁶

¹Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
²Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
³Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
⁴Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
⁵Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Korea
⁶Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
⁷Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea
⁸Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
⁹Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
¹⁰Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
¹¹Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
¹²Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
¹³Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
¹⁴Division of Cardiology, Department of Internal Medicine, SM Christianity Hospital, Pohang, Korea
¹⁵Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
¹⁶Division of Cardiology, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Korea

Corresponding Author: Seung-Hwan Lee , Tel: +82-33-741-0920, Fax: +82-33-741-1219, Email: carshlee@yonsei.ac.kr

Received: October 9, 2025; Revised: December 2, 2025; Accepted: January 12, 2026.

Abstract

Background/Aims: Distal radial access (DRA) has been associated with fewer access-site complications, but evidence in acute coronary syndrome (ACS) remains limited. This study evaluated the feasibility and safety of DRA in ACS patients with good arterial pulsation.
Methods: Patients with good arterial pulsation from the prospective, multicenter KODRA registry were analyzed, comparing those with ACS (n = 1,618) and non-ACS (n = 2,588). The primary efficacy endpoint was successful coronary angiography (CAG) without access-site crossover. The primary safety endpoint was DRA-related bleeding, and the secondary safety endpoint was radial artery occlusion (RAO). Multivariable logistic regression was performed to assess the association between ACS and study endpoints.
Results: The mean age was 66.3 ± 11.9 years, and 69.6% were male. The rate of successful CAG without access-site crossover was comparable between ACS and non-ACS patients (94.2% vs. 94.9%, p = 0.094). DRA-related bleeding occurred more frequently in ACS (4.3% vs. 2.6%, p = 0.002). RAO rates were similar before discharge (0.1% vs. 0.2%, p = 0.396), but lower at one-month in ACS patients (0.3% vs. 1.0%, p = 0.010). ACS was not independently associated with either primary efficacy (OR 0.871, 95% CI 0.664–1.144) or primary safety endpoint (OR 0.817, 95% CI 0.538–1.240).
Conclusions: In patients with good arterial pulsation, DRA was feasible in ACS, with higher bleeding but lower RAO compared with non-ACS. ACS was not independently associated with procedural failure or DRA-related bleeding. DRA may be considered a reasonable access strategy in selected ACS patients.

Keywords: Radial artery ; Acute coronary syndrome ; Coronary angiography ; Bleeding