Key result
ECG-guided culprit-first PCI linked to ~3-minute faster cath-to-balloon time without improving door-to-balloon time.
Why the study?
The study aimed to compare the procedural efficiency and clinical outcomes of ECG-guided culprit-first intervention versus an angiography-based strategy using a single transradial guiding catheter in STEMI patients undergoing primary PCI.
Does an ECG-guided culprit-first intervention reduce reperfusion times compared to an angiography-based strategy in STEMI patients undergoing transradial PCI?
Cohort (n=494)
No
Does an ECG-guided culprit-first intervention reduce reperfusion times compared to an angiography-based strategy in STEMI patients undergoing transradial PCI?
Absolute Event Rate: 20.96% vs 23.55%
p-value: p=0.01
An ECG-guided culprit-first strategy during transradial PCI for STEMI reduces catheterization lab-to-balloon and puncture-to-balloon times compared to an angiography-based approach, though total door-to-balloon time is similar.
May support ECG-guided workflow feasibility in STEMI PCI; hypothesis-generating and requires prospective RCTs before practice change.
The single transradial guiding catheter (STGC) technique has emerged as a promising approach to minimize catheter exchanges and optimize reperfusion timelines in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This study aimed to compare the procedural efficiency and clinical outcomes of two STGC-based strategies: electrocardiogram (ECG)-guided culprit-first intervention and angiography-based group. A retrospective cohort study was conducted on 494 STEMI patients who underwent transradial PCI using a 6Fr IL3.5 (Terumo) STGC at Jiading District Central Hospital between January 2022 and December 2024. Patients were stratified into two groups based on procedural workflow: the ECG-guided group ( n = 128) underwent immediate culprit vessel PCI guided by preoperative ECG followed by contralateral angiography, while the angiography-based group ( n = 366) received bilateral diagnostic angiography prior to culprit vessel intervention. Primary endpoints included door-to-balloon (D2B), catheterization lab-to-balloon (C2B), and puncture-to-balloon (P2B) times. Secondary endpoints encompassed procedural success rate, 30-day major adverse cardiac events (MACE), and operator preference. The ECG-guided group demonstrated significantly shorter median C2B (20.96 vs. 23.55 min, p = 0.01) and P2B times (13.89 vs. 16.06 min, p < 0.01) compared to the angiography-based group. However, there was no statistically significant difference in D2B time between the two groups (50.46 vs. 56.44 min, p = 0.36). Both groups achieved high procedural success rates (98.43% vs. 99.18%, p = 0.68) and comparable post-PCI Thrombolysis In Myocardial Infarction flow grade(TIMI)-3 flow rates (98.44% vs. 99.18%). Culprit vessel distribution differed significantly ( p < 0.001), with left anterior descending artery (LAD) predominance in the ECG-guided group (71.88%) and a more balanced distribution between right coronary artery (RCA) and LAD in the angiography-based group. Operator preference strongly influenced strategy selection ( p = 0.002), with four operators showing varying inclinations towards angiography-based group (66.67∽87.18%). No significant differences were observed in 30-day MACE (cardiac death, reinfarction, target vessel revascularization) or stroke rates (all p > 0.05). In STEMI patients undergoing transradial PCI with an IL3.5 single transradial guiding catheter, the ECG-guided culprit-first strategy was associated with significantly shorter C2B and P2B times compared with the angiography-based approach. However, no significant difference was observed in total D2B time between the two strategies.
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Yan et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=494). ECG-guided culprit-first intervention vs. Angiography-based revascularization was evaluated on Catheterization lab-to-balloon (C2B) time (minutes) (p=0.01). In STEMI patients undergoing transradial PCI, an ECG-guided culprit-first strategy significantly reduced median catheterization lab-to-balloon time (20.96 vs. 23.55 min) compared to an angiography-based approach, but did not significantly reduce total door-to-balloon time.
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