Incidence and determinants of non-radial vascular approach for coronary angiography in heart transplant recipients - 16/10/26

Doi : 10.1016/j.acvd.2026.07.009

Niki Procopi ^b, Paul Guedeney ^b, Arnaud Ferrante ^b, Michel Zeitouni ^b, Mathieu Kerneis ^b, Olivier Barthelemy ^b, Claude Le Feuvre ^b, Johanne Silvain ^b, Emmanuel Berman ^b, Ghilas Rahoual ^b, Victorien Monguillon ^b, David Sulman ^b, Marie Dupuy ^b, Louis Giovachini ^b, Pierre Charleux ^b, Guillaume Coutance ^c, Shaida Varnous ^c, Pascal Leprince ^c, Guillaume Lebreton ^c, Gilles Montalescot ^b, Gérard Helft ^a,⁎

^a Sorbonne Université, INSERM UMRS 1166, Paris, 75013, France

^b ACTION Study Group, Sorbonne Université, Inserm, UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP–HP, Paris, 75013, France

^c Sorbonne Université, Thoracic and Cardiovascular Surgery Department, AP–HP, Groupe Hospitalier Pitié-Salpétrière, Institute of Cardiology, Paris, 75013, France

^⁎ Corresponding author at: Institut de Cardiologie, Pitié-Salpêtrière Hospital, 47–83, boulevard de l’Hôpital, 75013 Paris, France. Institut de Cardiologie, Pitié-Salpêtrière Hospital 47–83, boulevard de l’Hôpital Paris 75013 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 16 October 2026

Graphical abstract

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Highlights

•	429 HT recipients undergoing coronary angiographies during median 6.7-year follow-up.
•	Patients had a median of three coronary angiographies during follow-up.
•	Median interval between coronary angiographies was 20 months.
•	A non-radial approach was possible in ∼ 2/3 patients.
•	Determinants of non-radial use: HT for ischemic heart disease, female, chronic dialysis, ≥ 2 HTs.

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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 [95% 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.

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Keywords : Coronary angiography, Radial access, Heart transplantation