Key result
Left distal radial artery access for primary PCI in STEMI patients achieved similar success rates to the transfemoral approach (90% vs 91.8%, p=0.795) with lower in-hospital mortality.
Why the study?
Although left distal radial artery access is increasingly popular in coronary angiography, little is known regarding its applicability in primary percutaneous coronary intervention for STEMI compared with the transfemoral route.
Does left distal radial artery access improve procedural metrics and clinical outcomes compared to transfemoral access in STEMI patients undergoing primary PCI?
Cohort (n=91)
Does left distal radial artery access improve procedural metrics and clinical outcomes compared to transfemoral access in STEMI patients undergoing primary PCI?
Absolute Event Rate: 90% vs 91.8%
p-value: p=0.795
Left distal radial artery access is a convenient and safe alternative to the transfemoral approach for primary PCI in STEMI, associated with reduced radiation exposure, shorter hospital stays, and lower in-hospital mortality.
May support LDRA over TF access for lower radiation and mortality in STEMI PCI; leaves open confirmation in randomized trials.
Background: Left distal radial artery (LDRA) has got high popularity as an alternative safe access site in coronary angiography. However, little is known about its applicability in primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients. We aimed to assess the convenience of LDRA access in STEMI patients and make the comparative evaluation with the transfemoral (TF) route. Materials and methods: A total of 91 consecutive STEMI patients who underwent PPCI from January to June 2019, were analyzed. Experienced operators, unaware of the study were left free of access site decision. Comparative demographic features and clinical outcomes were recorded during hospitalization. Results: LDRA was used in 30 patients, whereas 61 patients underwent a TF approach. Successful PPCI was achieved in high rates in both groups (LDR: 90% vs TF: 91.8%: p = 0.795). On admission, KILLIP (II, III) class was higher in the LDRA group (23.3% vs 3.4%), whereas stent thrombosis, arhythmias were higher in the TF group (0% vs 6.6% p = 0.151; 6.7% vs 18% p = 0.355 respectively). Puncture time was relatively similar between groups (28.63 vs 28.93 s p = 0.767). Fluoroscopy time, total radiation exposure and hospital duration was found lower in the LDRA group (10.11 vs 13.75 min p < 0.001; 917.87 vs 1940.91 mGy p < 0.001; 4.2 vs 6.2 days p = 0.024 respectively). In-hospital mortality was found higher in the TF group (0% vs 18% p = 0.013). Conclusion: In the acute management of STEMI, LDRA access site can be a convenient alternative to TF approach with shorter hospital duration and complication rates.
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Soydan et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=91). Left distal radial artery (LDRA) access vs. Transfemoral (TF) approach was evaluated on Successful PPCI (p=0.795). Left distal radial artery access for primary PCI in STEMI patients achieved similar success rates to the transfemoral approach (90% vs 91.8%, p=0.795) with lower in-hospital mortality.
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