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Background: Due to randomized trials demonstrating reduced bleeding with radial access, there is increasing use of radial access for percutaneous coronary intervention (PCI) across the United States. However, with declining rates of femoral access, there is concern that operators and patient care teams have become less familiar with management of femoral access. We describe vascular access complications associated with PCI in Michigan from 2013-2017. Methods: All PCIs from 1/1/2013 through 9/30/2017 from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry were included. The composite vascular complications endpoint included post-procedure pseudoaneurysm, AV fistula, neuropathy, RP hematoma, acute thrombosis, need for surgical repair, and loss of limb. Hierarchical generalized linear mixed effects regression was used to adjust for patient and procedural characteristics and account for site and operator level variability. Results: From 2013 to 2017, the use of radial access has increased from 25.9% to 44.6%. Vascular complications were consistently less frequent in radial access cases throughout the study period. Complications for both femoral and radial access cases increased over time, with overall complication rates relatively constant (figure). After adjusting for patient and procedural characteristics, as well as site and operator variability, radial access was significantly associated with lower complication risk (aOR = 0.1881, p < 0.001), while for both radial and femoral cases complications increased with time (aOR = 1.014 per quarter, p = 0.003). Conclusions: Despite increased use of trans-radial PCI in Michigan, there has been no significant change in the overall rate of vascular access site complications, attributable in large part to worsening vascular outcomes with femoral access. These data highlight the need to develop new strategies to mitigate vascular complications in the trans-radial era. [ABSTRACT FROM AUTHOR]