Key result
Left radial approach for primary PCI in STEMI significantly reduced needle-to-balloon time compared to right radial approach (16.0±4.8 vs 18.0±6.5 minutes; P=0.02).
Why the study?
Does the left radial approach reduce needle-to-balloon time compared to the right radial approach in STEMI patients undergoing primary PCI?
RCT (n=200)
randomized
Does the left radial approach reduce needle-to-balloon time compared to the right radial approach in STEMI patients undergoing primary PCI?
Absolute Event Rate: 16% vs 18%
p-value: p=0.02
The left radial approach for primary PCI in STEMI patients is feasible and significantly reduces needle-to-balloon time and radiation exposure compared to the right radial approach.
Supports preferring left radial access in STEMI primary PCI; extends randomized evidence on radial route optimization.
BACKGROUND: Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS: A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated. RESULTS: There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA. CONCLUSION: Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
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Fu et al. (2015) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=200). Left radial approach (LRA) vs. Right radial approach (RRA) was evaluated on Needle-to-balloon time (p=0.02). Left radial approach for primary PCI in STEMI significantly reduced needle-to-balloon time compared to right radial approach (16.0±4.8 vs 18.0±6.5 minutes; P=0.02).
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