Predictors of a prolonged puncture-wire time in patients with ST-Elevation Myocardial Infarction (STEMI)

Background In patients with ST-elevation myocardial infarction (STEMI), rapid reperfusion is essential for optimal outcomes, yet factors influencing intraprocedural delays remain insufficiently investigated. Methods In this single-center retrospective study, consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) between 2015 and 2024 were analyzed. Prolonged time between vascular puncture and wire passage (puncture-wire time; PWT) was defined as a value in the fourth quartile of the study population (>17.1 minutes). Multivariable logistic regression identified independent predictors and procedural determinants of prolonged PWT. Results A total of 1,235 patients (70.7% male, median age 64.5 years [IQR 56.0–75.25]) were included. Radial-to-femoral access crossover (OR 2.539, 95% CI 1.381–4.665, p = 0.003), arterial kinking or severe radial spasm (OR 3.669, 95% CI 1.986–6.778, p < 0.001) and challenging revascularization of the culprit lesion (OR 2.330, 95% CI 1.319–4.116, p = 0.004) were independently associated with prolonged PWT. Direct intervention of the culprit lesion was independently associated with a lower likelihood of prolonged PWT (OR 0.445, 95% CI 0.201 – 0.988, p = 0.047). In contrast, the primary choice of vascular access (radial vs. femoral) was not associated with prolonged PWT (p=0.06). Conclusion While some factors are system- or patient-dependent, early recognition of procedural difficulties and individualized access-site decision making may help minimize procedural delays. In selected patients, a primary femoral access route may be considered, and direct intervention of the culprit lesion should be pursued to minimize PWT. Clinical trial number Not applicable.