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Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary
Qiang Fu1, Hongyu Hu1, Dezhao Wang1
1Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Insights
The left radial approach (LRA) offers faster blood flow restoration and reduced radiation exposure during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients compared to the right radial approach (RRA). LRA is a feasible alternative for STEMI treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Left radial approach (LRA) shows promise in reducing procedure time and complications in elective percutaneous coronary intervention (PCI).
- Limited data exists on the feasibility and efficacy of LRA in primary PCI for ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To compare the efficacy of LRA versus the right radial approach (RRA) for primary PCI in STEMI patients.
- To evaluate procedural outcomes, including time to reperfusion and radiation exposure.
Main Methods:
- 200 STEMI patients undergoing primary PCI were randomized to LRA (n=100) or RRA (n=100).
- Key endpoints included needle-to-balloon time, radiation dose (cumulative air kerma and dose area product), fluoroscopy time, and contrast volume.
Main Results:
- Procedural success rates were comparable between LRA and RRA (98% vs. 94%, P=0.28).
- LRA demonstrated significantly shorter needle-to-balloon times (16.0±4.8 min vs. 18.0±6.5 min, P=0.02).
- LRA resulted in significantly lower fluoroscopy time and cumulative air kerma dose area product compared to RRA.
Conclusions:
- Primary PCI in STEMI patients can be effectively performed using LRA.
- LRA facilitates earlier reperfusion and reduces radiation exposure compared to RRA.
- LRA presents a feasible and attractive alternative for primary PCI in STEMI.
Background:
Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients.
Materials And Methods:
A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated.
Results:
There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA.
Conclusion:
Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
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