Switching from femoral to routine radial access site for ST-elevation myocardial infarction: a single center...

This study sought to describe the change of first choice access site from transfemoral (TF) to transradial (TR) in primary percutaneous coronary intervention (pPCI) in a single center.

TR-pPCI, when performed by experienced operators, can reduce bleeding events and improve clinical outcome. However, little is known about the learning curve of TR-pPCI and the results obtained by less experienced operators.

Time to reperfusion, contrast and radiation doses, and 30-day clinical events were evaluated. The relationship between operator experience and procedural results was assessed.

During 6.5 years, 1,045 patients with STEMI underwent pPCI. The rate of TR-pPCI increased gradually from about 40% to 90% and remained stable thereafter. The crossover from TR to TFpPCI occurred in 4.6% of patients and was not related to the operator experience. Patients selected for TR-pPCI had a lower risk profile and lower incidence of 30-day mortality and bleeding events. Time to reperfusion, contrast volume, fluoroscopy time, and angiographic success was not significantly different between the 2 vascular approaches, nor was it associated to the operator experience. At roughly 200 PCIs as operator experience, a slight adjusted reduction in the time form first coronary angiogram to balloon was detected with both vascular approaches.

A progressive transition from TF to TR-pPCI could be implemented over a 4-year period without increasing overall treatment delay. The impact of operator experience on procedural results appeared to be modest and it did not differ in the study access groups.