Single‐Catheter Versus Conventional Two‐Catheter Primary PCI in STEMI: A 1:1 Propensity Score‐Matched Cohort Study

BACKGROUND: Primary percutaneous coronary intervention (pPCI) is the gold-standard reperfusion strategy for acute ST-elevation myocardial infarction (STEMI). However, the conventional two-catheter percutaneous coronary intervention (C-PCI) workflow requires sequential use of diagnostic and guiding catheters, causing avoidable procedural delays. Single-catheter percutaneous coronary intervention (SC-PCI) uses a single universal guiding catheter for both coronary angiography and intervention, improving intraprocedural efficiency, but comparative data remain limited. METHODS: This single-center retrospective cohort study enrolled 268 consecutive STEMI patients undergoing transradial pPCI. Using 1:1 propensity score matching (PSM), baseline confounders were balanced between the SC-PCI and C-PCI groups. The primary endpoint was puncture-to-balloon (P2B) time; secondary endpoints included core procedural time metrics, intraprocedural exposure, safety, and short-term outcomes. Exploratory subgroup analyses were performed to assess the consistency of treatment effect. RESULTS: After PSM, 120 well-balanced patients (60 per group) were included. SC-PCI significantly reduced P2B time (median 9.5 vs. 15.5 min, p < 0.001), along with shorter puncture-to-angiography time, cath-lab door-to-balloon time, fluoroscopy duration, and lower contrast volume (all p < 0.05). No statistically significant differences were observed in procedural success, overall complication rates, or in-hospital mortality between groups. In exploratory subgroup analyses, the P2B benefit was consistent across subgroups, with no significant interactions (all p for interaction > 0.05). CONCLUSION: In this propensity-matched STEMI cohort, SC-PCI was associated with shorter P2B time and improved intraprocedural efficiency, with no significant differences in periprocedural safety outcomes, suggesting that SC-PCI may be a promising strategy to optimize STEMI interventional workflows.