Systematic use of transradial PCI in patients with ST-segment elevation myocardial infarction: a call to "arms"

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Transradial percutaneous intervention (TRI) is gaining support as a preferred access site for ST-segment elevation myocardial infarction (STEMI).
• Historically, concerns regarding procedure time, door-to-device time, and operator experience limited TRI use in STEMI.
• Growing evidence highlights the link between periprocedural bleeding and mortality in acute coronary syndromes, increasing interest in TRI for bleeding reduction.

Purpose of the Study:

• To review the current evidence supporting transradial percutaneous intervention (TRI) in STEMI patients.
• To address barriers to TRI adoption and advocate for its increased implementation in STEMI treatment.

Main Methods:

• Systematic review of registry data, meta-analyses, and randomized control trials comparing TRI with transfemoral access in STEMI.
• Analysis of factors influencing TRI adoption rates and clinical practice barriers.

Main Results:

• TRI is associated with significantly reduced periprocedural bleeding and lower mortality compared to transfemoral access in STEMI.
• TRI offers additional benefits including enhanced patient comfort, shorter hospital stays, and reduced costs.
• Despite evidence, TRI adoption in the US remains slow due to clinical practice barriers and uncertainty about mortality reduction causality.

Conclusions:

• Transradial percutaneous intervention (TRI) is a safe and effective access site for STEMI, demonstrating reduced bleeding and mortality.
• Increased training in cardiovascular fellowship programs and post-fellowship courses is crucial for widespread TRI implementation.
• A call to action is proposed to overcome barriers and promote greater use of TRI in STEMI management.