Procedural Characteristics and Safety of Slender Percutaneous Coronary Intervention: Slender Is Better.

Objectives: We aimed to examine the procedural characteristics and safety profile of slender percutaneous coronary interventions (PCI) using a 5 Fr or smaller sheath.

Background: Smaller catheter size has been associated with fewer complications in PCI.

Methods: Our retrospective observational study included 259,401 cases of stable elective PCI from the Japan Percutaneous Coronary Intervention Registry between 2021 and 2022. Based on sheath size, cases were categorized into the slender group (5 Fr or smaller, n = 28,300) and the non-slender group (6 Fr or larger, n = 231,101).

Results: The slender group was associated with more radial access (88.6% vs. 74.2%: p < 0.001), fewer PCI failures (1.7% vs. 2.8%, p < 0.001), shorter procedural times (86.1 ± 47.2 min vs. 103.0 ± 65.1 min, p < 0.001), lower contrast medium usage (104.0 ± 54.8 mL vs. 126.0 ± 69.0 mL, p < 0.001), and shorter fluoroscopy times (25.9 ± 20.0 min vs. 32.4 ± 26.9 min, p < 0.001). Additionally, the slender group experienced fewer complications, including procedure-related myocardial infarction (odds ratio [OR] 1.25, p = 0.004), cardiac tamponade (OR 1.52, p = 0.048), heart failure or cardiogenic shock (OR 1.57, p < 0.001), stent thrombosis (OR 2.42, p = 0.02), emergency surgery (OR 3.45, p = 0.02), and bleeding complications at both the access (OR 3.16, p < 0.001) and non-access sites (OR 1.94, p = 0.02). Although the in-hospital mortality rate was slightly lower in the slender group, this difference was not statistically significant (OR 1.11, p = 0.39).

Conclusions: Slender PCI using a 5 Fr or smaller sheath was associated with a favorable safety profile, shorter procedural times, and fewer complications compared to larger sheath sizes.