Key result
Transradial intervention with a single Ikari left catheter for STEMI was feasible (96.9% success) and resulted in a median door to perfusion time of 90 minutes versus 98 minutes for transfemoral intervention (P=0.07).
Why the study?
Does transradial coronary intervention with a single Ikari left guiding catheter improve procedural times and outcomes compared to conventional transfemoral intervention in STEMI patients?
Cohort (n=362)
Does transradial coronary intervention with a single Ikari left guiding catheter improve procedural times and outcomes compared to conventional transfemoral intervention in STEMI patients?
Absolute Event Rate: 90% vs 98%
p-value: p=0.07
Transradial intervention using a single Ikari left guiding catheter is feasible in STEMI patients and yields comparable procedural times and clinical outcomes to the transfemoral approach.
Supports single-catheter transradial STEMI access; leaves open randomized confirmation of time or outcome benefits versus transfemoral.
BACKGROUND: Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients. METHODS: This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis. RESULTS: TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 - 119.5) versus 98 (IQR 80.8 - 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 - 45.0) versus 37 (IQR 28.0 - 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups. CONCLUSION: In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.
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Chow et al. (2012) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=362). Transradial coronary intervention with a single Ikari left guiding catheter vs. Conventional transfemoral intervention (TFI) was evaluated on Door to perfusion time (minutes) (p=0.07). Transradial intervention with a single Ikari left catheter for STEMI was feasible (96.9% success) and resulted in a median door to perfusion time of 90 minutes versus 98 minutes for transfemoral intervention (P=0.07).
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