scholarly journals TCT-363 Patient Characteristics Influencing Physician Selection of Radial vs. Femoral Access in patients presenting emergently with ST-Elevation Myocardial Infarction

2016 ◽  
Vol 68 (18) ◽  
pp. B149
Author(s):  
Jimmy Yee ◽  
James Higgins ◽  
Vishesh Kumar ◽  
Amornpol (Song) Anuwatworn ◽  
Shenjing Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Patient Characteristics ◽  
St Elevation Myocardial Infarction ◽  
Femoral Access ◽  
St Elevation ◽  
Selection Of

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

The selection of β-blocker after successful reperfusion in patients with ST-elevation myocardial infarction

Perfusion ◽  
2019 ◽  
Vol 35 (4) ◽  
pp. 338-347
Author(s):  
Ho-Jun Jang ◽  
Jon Suh ◽  
Sung Woo Kwon ◽  
Sang-Don Park ◽  
Pyung Chun Oh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Target Vessel ◽  
Primary Intervention ◽  
Target Vessel Revascularization ◽  
Recurrent Myocardial Infarction ◽  
St Elevation ◽  
Β Blocker ◽  
Β Blockers ◽  
Selection Of

Background: The selection of β-blocker for survivors after primary intervention due to acute ST-elevation myocardial infarction seems crucial to improve the outcomes. However, rare comparison data existed for these patients. We aimed to compare the effectiveness of selective β-blockers to that of carvedilol in patients treated with primary intervention. Methods and results: Among the 1,485 patients in the “INTERSTELLAR” registry between 2007 and 2015, 238 patients with selective β-blockers (bisoprolol, nebivolol, atenolol, bevantolol, and betaxolol) and 988 with carvedilol were included and their clinical outcomes were compared for a 2-year observation period. In the clinical baseline characteristics, the unfavorable trends in the carvedilol group were high Killip presentation, lower ejection fractions, smaller diameters, and longer lengths of deployed stents. Although mortality (2.5% vs. 1.7%; p = 0.414) and the rate of stroke (0.8% vs. 0.6%; p = 0.693) were not different between groups, the rate of recurrent myocardial infarction (4.6% vs. 1.2%; p = 0.001) and of target vessel revascularization (4.2% vs. 0.9%; p < 0.001) were lower in the carvedilol group. After eliminating the difference by propensity matching, the similar outcome result was shown (all-cause death, 0.6% vs. 1.0%, p = 0.678; stroke, 0.6% vs. 1.2%, p = 0.479; myocardial infarction, 5.0% vs. 1.2%, p = 0.003; target vessel revascularization, 4.5% vs. 0.7%, p < 0.006) for 595 matched populations. The use of carvedilol was also determined to be an independent predictor for recurrent myocardial infarctions (hazard ratio = 0.305; p = 0.005; 95% confidence interval = 0.13-0.69). Conclusion: Use of a carvedilol in ST-segment myocardial infarction survivor is associated with lower recurrent myocardial infarction events. Thus, it might be the better choice of β-blocker for secondary prevention in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention.

scholarly journals Comparison of Distal Radial, Proximal Radial, and Femoral Access in Patients with ST-Elevation Myocardial Infarction

2021 ◽  
Vol 10 (15) ◽  
pp. 3438
Author(s):  
Oh-Hyun Lee ◽  
Yongcheol Kim ◽  
Nak-Hoon Son ◽  
Ji Woong Roh ◽  
Eui Im ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Primary Pci ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary ◽  
Feasible Alternative ◽  
Experienced Operator ◽  
St Elevation

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.

scholarly journals Correlates of Delayed Initial Contact to Emergency Services among Patients with Suspected ST-Elevation Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Osayi Lawani ◽  
Nicholas Gorman ◽  
Fiona Gorman ◽  
Jiries Ganim ◽  
Stefano Sdringola-Maranga
Keyword(s):  
Myocardial Infarction ◽  
Health Outcomes ◽  
Symptom Onset ◽  
Patient Characteristics ◽  
St Elevation Myocardial Infarction ◽  
Future Research ◽  
Stepwise Logistic Regression ◽  
Initial Contact ◽  
Total Delay ◽  
St Elevation

Background. Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction. Objective. To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes. Methods. A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care. Results. Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes. Conclusions. Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.

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