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Brachial approach to emergency cardiac catheterization during thrombolytic therapy for acute myocardial infarction.
B S George1, R J Candela, E J Topol
1Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Insights
The transbrachial approach for acute coronary intervention is as safe and effective as the traditional femoral approach. This study found similar risks and outcomes for patients undergoing cardiac catheterization and angioplasty using either method.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The brachial approach for acute coronary intervention (ACI) has not been extensively studied.
- The femoral approach is the conventional method for cardiac catheterization and angioplasty.
Purpose of the Study:
- To evaluate the safety and efficacy of the transbrachial approach compared to the femoral approach for ACI.
- To assess procedural outcomes and complication rates associated with the transbrachial approach.
Main Methods:
- Analysis of data from the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials.
- Comparison of 202 patients (28.6%) who underwent transbrachial cardiac catheterization with or without angioplasty against those using the femoral approach.
- Evaluation of baseline characteristics, procedural times, patency rates, technical success, and clinical outcomes.
Main Results:
- No significant differences in baseline characteristics or time to angiography between brachial and femoral approaches.
- Comparable chemical patency (78% vs. 73%) and higher technical success for brachial angioplasty (89% vs. 78%).
- Similar rates of death (6%), reocclusion (10% vs. 14%), emergency bypass surgery (5% vs. 6%), vascular repair (1% vs. 3%), and retroperitoneal hemorrhage (1%).
Conclusions:
- The transbrachial approach is a viable alternative for ACI in the acute phase.
- Experienced operators can utilize the transbrachial approach with risks and efficacy comparable to the femoral approach.
- This finding supports the transbrachial approach as an equally effective option for acute coronary intervention.
Abstract:
The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704 (28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1 +/- 26 min vs. 99.9 +/- 133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death (6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9 +/- 4.4 and 43.5 +/- 4.8, respectively with a nadir of 32.9 +/- 5.6 vs. 33.0 +/- 5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in the hands of experienced operators the transbrachial approach to acute coronary intervention in the acute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy as the femoral approach.