{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:22:07Z","timestamp":1783642927943,"version":"3.55.0"},"reference-count":16,"publisher":"Korean Association of Internal Medicine","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Samjin Pharmaceutical Co., Ltd."},{"name":"Gangwon Chapter of the Korean Society of Cardiology"}],"content-domain":{"domain":["kjim.org"],"crossmark-restriction":true},"short-container-title":["Korean J Intern Med"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>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 \u00b1 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\u20131.144) or primary safety endpoint (OR 0.817, 95% CI 0.538\u20131.240).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.<\/jats:p>","DOI":"10.3904\/kjim.2025.349","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:47:12Z","timestamp":1782956832000},"page":"663-675","update-policy":"https:\/\/doi.org\/10.3904\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal radial access in acute coronary syndrome patients with good arterial pulsation: a subgroup analysis from the KODRA registry"],"prefix":"10.3904","volume":"41","author":[{"given":"Jun-Won","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Yong","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Ho","family":"Heo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Young","family":"Jin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Woo","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongcheol","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong-Ki","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Yong","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Yeub","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Sup","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Hoi","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Bae","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Kie","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Ho","family":"Bae","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, SM Christianity Hospital, Pohang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Yun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1186-0917","authenticated-orcid":true,"given":"Seung-Hwan","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2270","reference":[{"key":"ref1","first-page":"3720","type":"journal-article","volume-title":"2023 ESC Guidelines for the management of acute coronary syndromes","author":"Byrne","year":"2023"},{"key":"ref2","first-page":"e771","type":"journal-article","volume-title":"2025 ACC\/AHA\/ACEP\/ NAEMSP\/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","author":"Rao","year":"2025"},{"key":"ref3","first-page":"329","type":"journal-article","volume-title":"Distal radial access for coronary procedures in a large prospective multicenter registry: the KODRA trial","author":"Lee","year":"2024"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-18-00635","type":"journal-article"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-92742-7","type":"journal-article"},{"key":"ref6","first-page":"2297","type":"journal-article","volume-title":"Distal vs conventional radial access for coronary angiography and\/or intervention: a meta-analysis of randomized trials","author":"Ferrante","year":"2022"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/mca.0000000000001489","type":"journal-article"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1530995","type":"journal-article"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/mca.0000000000001411","type":"journal-article"},{"key":"ref10","first-page":"22","type":"journal-article","volume-title":"Distal or traditional transradial access site for coronary procedures: a single-center, randomized study","author":"Tsigkas","year":"2022"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-025-04005-1","type":"journal-article"},{"key":"ref12","first-page":"102200","type":"journal-article","volume-title":"Distal radial access vs transradial access in patients with ST-segment elevation myocardial infarction: the DRAMI trial","author":"Lee","year":"2025"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2025.08.007","type":"journal-article"},{"key":"ref14","first-page":"1191","type":"journal-article","volume-title":"Distal versus conventional radial access for coronary angiography and intervention: the DISCO RADIAL trial","author":"Aminian","year":"2022"},{"key":"ref15","first-page":"e366","type":"journal-article","volume-title":"Distal access and procedural anticoagulation to prevent radial artery occlusion after coronary angiography - the randomised RAPID trial","author":"Stiermaier","year":"2025"},{"key":"ref16","first-page":"2235","type":"journal-article","volume-title":"Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: an international consensus paper","author":"Bernat","year":"2019"}],"container-title":["The Korean Journal of Internal 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