Effectiveness of a change in reperfusion strategy to primary percutaneous coronary intervention in a nonselected population

Comparison of door-to-balloon times for primary PCI using transradial versus transfemoral approach

OBJECTIVES

The objective of this study was to compare door-to-balloon times and other variables in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) using transfemoral or transradial approaches.

BACKGROUND

Transradial PCI has been shown to lower the risk of access site complications but the procedure is not applied to STEMI patients, due to concerns of procedural complexity adversely affecting prompt reperfusion. There is paucity of real-world data comparing TRI with TFI in patients with STEMI.

METHODS

Three hundred sixteen consecutive patients with STEMI undergoing primary PCI were studied. Patients were divided in two groups, Group I (n = 204) undergoing PCI transfemorally and Group II (n = 109) patients transradially. Demographic data, door-to-balloon times, procedural variables, predischarge adverse events, access site complications, and 1 year follow-up major adverse cardiac events (MACE) were recorded.

RESULTS

Door-to-balloon time was 72 +/- 14 min in Group I compared with 70 +/- 17 min in Group II, the difference was not statistically significant (t = 1.096, P > 0.27). Group II patients had significantly fewer access site complications compared with Group I (20 vs. 1 patient, chi(2) = 10.8, P < 0.05). Demographics, predischarge adverse events, and MACE at 1 year follow-up were comparable between the two groups.

CONCLUSIONS

Transradial approach to primary PCI provides similar door-to-balloon times to transfemoral approach, and significantly lowers access site related complications, in patients presenting with STEMI.