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Background Radial access is traditionally the first line method for percutaneous coronary interventions (PCI). However, it has its drawbacks. Recently a new distal radial approach (DRA) has been proposed. The results of using this method in patients with ACS are not defined. Aim of this study To evaluate the safety, efficacy and hospital outcomes ot treatment of patients with ACS using DRA during PCI as compared to traditional radial access (TRA). Materials and methods A single-center randomized trial included 264 people who underwent PCI in the period from November 2018 to May 2019 at our clinic. The proportion of patients with unstable angina was 60.6% (n=160), with acute myocardial infarction 39.4% (n=104). Patients were divided into 2 groups: in the 1st gr. (n=132) was used DRA, in the control 2nd gr. (n=132) - TRA. The studied groups were comparable according to the initial clinical and angiographic data. All interventions were performed by experienced endovascular cardiologists who perform more than 300 PCI per year. Statistical methods We used a program Statistica 6.0, v. 15, Pearson's criterion, Fisher's exact test, t-test. Results During PCI, 228 drug-coated stents were implanted in 104 patients. 10 patients had access conversion during PCI: from DRA to TRA in 3 patients, to femoral access - in 4 (the total number of conversions from DRA was 5.3%), from transradial to femoral in 3 people (2.3%), and therefore in the 1st group left 125 patients for observation, in the second - 129, respectively. The average puncture time was 125.1±11.9 sec. in the 1 gr. and 58.8±8.2 sec. in the 2 gr. (p≤0.00005). There was no difference in the total execution time of PCI: 30.5±7.1 min. in the 1 gr. and 29.4±4.6 min. in the 2 gr. (p≥0.1428). The duration of hemostasis was significantly higher in the TRA group: 354.2±28.1 min. against 125.4±15.3 min. in the 1 gr. (p≤0.00005). In the DRA group, there was a lower incidence of hematomas: in 1 patient (0.8%) versus 9 (7.0%) in the TRA group (p=0.019), radial artery spasm: in 7 patients (5.6%) versus 17 (13.2%) in the 2 gr. (p=0.039) and thrombosis at the access site: occlusion radial artery was observed only in 1 patient (0.8%) in the DRA group, while in the TRA group - in 8 (6.2%), p=0.036. The frequency of Major Adverse Cardiac Events (MACE) in the studied groups at the hospital stage was similar: 2.4% of cases (n=3) in the 1st gr. and 2.3% (n=3) in the 2nd group (p=1.0). Conclusions Our one-center prospective study showed: The use of distal radial access does not extend the overall procedure time compared to transradial approach. The frequency of major complications is comparable in the two studied groups. We noted a significantly lower frequency of local complications when using DRA compared to TRA. So, distal radial approach may be an alternative to transradial access, however, large randomized trials are needed for a final conclusion. Funding Acknowledgement Type of funding source: None

Hospital results of endovascular treatment of patients with Acute Coronary Syndrome (ACS) through distal radial access