Radial vs femoral access for percutaneous coronary artery intervention in patients with ST-elevation myocardial infarction

Recent studies have indicated that distal radial access (DRA) is feasible in patients undergoing percutaneous coronary intervention (PCI). The present study aimed to compare DRA, proximal radial access (PRA), and femoral access (FA) in patients with ST-elevation myocardial infarction (STEMI) undergoing PCI. Data were analyzed for 109 patients with STEMI treated via primary PCI from March 2020 to May 2021. The success rate of DRA was 83.3% (35/42), including seven cases of failed puncture (puncture failure = 5, severe radial artery spasm = 2). Primary PCI via the DRA was successful in all 35 patients. After classifying the patients requiring crossover into a separate group, the percentage of the puncture time in the door-to-wiring time was 2.7% [2.2–4.3], 3.3% [2.3–4.0], 2.6% [1.2–4.9], and 27.0% [13.5–29.3] in the DRA (n = 35), PRA (n = 24), FA (n = 26), and crossover (n = 9) groups, respectively (p < 0.01). Only two local hematomas (≤5 cm) occurred in the DRA group, while one patient in the FA group required surgical treatment and a transfusion for an access-site vascular injury. When performed by an experienced operator, DRA may represent a feasible alternative to other access routes in select patients with STEMI undergoing PCI, such as those with a high risk of bleeding.

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A szívinfarktusért felelős ér prognosztikus jelentőségének vizsgálata ST-elevációs szívinfarktusos betegekben

Orvosi Hetilap ◽

10.1556/650.2016.30506 ◽

2016 ◽

Vol 157 (32) ◽

pp. 1282-1288

Author(s):

András Jánosi ◽

Péter Ofner ◽

Dániel Simkovits ◽

Tamás Ferenci

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Left Circumflex Artery ◽

Percutaneous Coronary ◽

St Elevation

Introduction: To the best of the authors’ knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention. Aim: The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention. Method: The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of time-to-death, controlling for age, sex, and comorbidities. Results: The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p<0.0001) factor of survival, with right coronary artery exhibiting a highly significantly better prognosis (hazard ratio 0.69, 95% CI 0.61–0.79, p<0.0001) and left main artery exhibiting a significantly worse prognosis (hazard ratio 1.56, 95% CI 1.04–2.35, p = 0.0321) than the reference vessel (left anterior descendent artery). Conclusion: These data demonstrate that the culprit vessel has independent prognostic significance. Orv. Hetil., 2016, 157(32), 1282–1288.

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Acute ST-elevation myocardial infarction (STEMI) in a patient with a single coronary artery successfully treated with primary percutaneous coronary intervention

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh160222014r ◽

2017 ◽

Vol 145 (1-2) ◽

pp. 70-72

Author(s):

Dusan Ruzicic ◽

Dragan Hrncic ◽

Milan Nikolic ◽

Marija Mirkovic ◽

Milijana Ruzicic

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Coronary Angiography ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Single Coronary Artery ◽

Percutaneous Coronary ◽

St Elevation

Introduction. A single coronary artery (SCA) is defined as a coronary artery that arises from the sinus of Valsalva and supplies the entire heart. This is a rare congenital anomaly occurring in approximately 0.04?0.13% of the population. SCA can be diagnosed during life by coronary angiography and multislice cardiac computed tomography. There are many anatomical variations of single coronary arteries. Case outline. A 50-year-old man presented with acute ST elevation myocardial infarction (STEMI). Coronary angiography revealed the case of an SCA with left anterior descending artery and circumflex artery arising separately from the right coronary artery which was occluded proximally to their taking-off. Successful primary percutaneous coronary intervention was performed and is reported here in details. This is the first described case of an SCA (classified as R-III and R-III-C by Lipton and Yamanaka, respectively) with a clinical presentation as STEMI. A description of the undertaken management is also provided. Conclusion. Coronary artery anomalies require accurate recognition in order to help cardiologists plan appropriate management of these patients.

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Radial versus femoral access for percutaneous coronary intervention in ST-elevation myocardial infarction patients treated with fibrinolysis: Results from the randomized routine early invasive clinical trials

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2016.03.008 ◽

2016 ◽

Vol 17 (5) ◽

pp. 295-301 ◽

Cited By ~ 5

Author(s):

John J. Graham ◽

Andrew T. Yan ◽

Mary K. Tan ◽

Warren J. Cantor ◽

Carlo DiMario ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trials ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Femoral Access ◽

Percutaneous Coronary ◽

St Elevation

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Target vessel reopening by guidewire insertion in ST-elevation myocardial infarction is a predictor of final TIMI flow and survival

Thrombosis and Haemostasis ◽

10.1160/th10-04-0246 ◽

2011 ◽

Vol 105 (01) ◽

pp. 52-58 ◽

Cited By ~ 3

Author(s):

Christopher Adlbrecht ◽

Klaus Distelmaier ◽

Duygu Gündüz ◽

Bassam Redwan ◽

Christian Plass ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Target Vessel ◽

Timi Flow ◽

Percutaneous Coronary ◽

Catheter Laboratory ◽

St Elevation ◽

Medical University

SummaryST-elevation myocardial infarction (STEMI) results from acute thrombotic obstruction of a coronary artery. Percutaneous coronary intervention (PCI) is the treatment of choice to restore blood flow. The incidence of guidewire-induced reopening of the infarct-related coronary artery (IRA) and its association with post-procedural TIMI flow and long-term mortality were assessed. Angiograms of consecutive STEMI patients admitted to the catheter laboratory of the Medical University of Vienna between January 2003 and December 2005 were analysed. TIMI flow was graded prior to and after guidewire insertion into the distality of the IRA, and at the end of the procedure. Initial TIMI 0 flow was present in 476 (47.0%) of 1,012 cases. Target vessel reopening after guidewire insertion defined as any flow >TIMI 0 flow occurred in 150 patients (37.2%), and was associated with improved survival after a median of 914 (609–1,238) days (p=0.017). Reflow after guidewire insertion was an independent predictor of post-procedural TIMI flow (odds ratio=3.10, 95% confidence interval [CI]=1.64 – 5.86], p<0.001) and mortality (hazard ratio=0.51, CI=0.28 – 0.94], p=0.029). Target vessel reopening by guidewire insertion is a new predictor of prognosis. Target vessel flow after guidewire insertion should be assessed in a standardised fashion during PCI.

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