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Direct Angioplasty for Acute Myocardial Infarction in Elderly Patients Using Transradial Approach
N. Delarche1, M. Idir, G. Estrade
1Centre Hospitalier, Pau, FranceI.
Insights
Direct coronary angioplasty (DCA) via the right transradial approach (RTRA) is feasible and safe for elderly patients with acute myocardial infarction (AMI). This method allows for successful treatment and earlier patient discharge.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Acute myocardial infarction (AMI) management often favors direct coronary angioplasty (DCA) over thrombolysis for better immediate outcomes.
- The right transradial approach (RTRA) is an alternative catheterization technique, yet rarely used for AMI treatment.
- Elderly patients present unique challenges in interventional cardiology procedures.
Purpose of the Study:
- To assess the feasibility and safety of performing DCA using the RTRA in elderly patients (≥70 years) experiencing AMI.
- To evaluate the procedural success rates and complication profiles of RTRA in this specific patient demographic.
Main Methods:
- Prospective study including 46 elderly patients (≥70 years) with AMI within 6 hours of symptom onset.
- Exclusion criteria included ischemic Allen Test and prior thrombolytic therapy.
- All patients underwent left heart catheterization and selective coronary angiography via the RTRA.
Main Results:
- RTRA catheterization was successful in 90.9% of patients; DCA was performed in 40 patients (100% success rate).
- Angioplasty involved balloon treatment in 52.5% and stenting in 47.5%.
- In-hospital mortality was 4.5% (2 patients with cardiogenic shock). Local complications included recurrent angina (4.5%) and radial artery occlusion (4.5%). 75% of patients were mobilized early and discharged within 7±4 days.
Conclusions:
- DCA utilizing the RTRA is a feasible and highly successful strategy for elderly patients with AMI.
- The RTRA offers a safety profile comparable to the femoral approach regarding major local complications.
- This technique facilitates early mobilization and discharge, improving patient management.
Abstract:
BACKGROUND: In acute myocardial infarction (AMI), immediate outcome seems to be better after direct coronary angioplasty (DCA) than thrombolysis. Right transradial approach (RTRA) has been currently advocated as an alternative catheterization method for coronary angioplasty, but it is an exceptional technique in the treatment of AMI. PURPOSE: The goal of this prospective study was to evaluate feasibility and safety of DCA using the RTRA in elderly patients. METHODS: All patients, 70 years or older with AMI (less than 6 hours after the onset of symptoms), were included in this study. Exclusion criteria were ischemic Allen Test, and previous thrombolytic treatment. Left heart catheterization, with selective coronary angiograms were realized in all of them, using RTRA. RESULTS: Forty six patients, (mean age 76Â+/-5, range 70-85), (31 men, 15 women), were included. Coronary catheterization using RTRA was not possible in 4 patients, (9.1%), and DCA was not necessary in 2 other patients with two distal lesions (4.5%). In the 40 remaining patients, transradial coronary angioplasty of the infarct related vessel could be successfully achieved in 40 patients, (100%) with balloon alone in 21 patients, (52.5%), or stents in 19 patients, (47.5%). Two patients with cardiogenic shock died (in hospital mortality: 4.5%). In 2 patients, recurrent angina needed new angioplasty using the same RTRA (4.5%), and in 2 other patients, asymptomatic postprocedural right radial artery occlusion was observed. Before the 24th hr, 30/40 patients (75%) could stand up with an early discharge, (7Â+/-4 days). CONCLUSION: DCA using RTRA for AMI in elderly patients can be easily realized, with a high rate of success, without any more major local complications than using the usual femoral route, allowing earlier getting up and discharge.