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Published on: June 12, 2021
Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and
Matthew S Schoenfeld1, Ibrahim Kassas1, Binita Shah2
1New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA.
Insights
Transradial access (TRA) for percutaneous coronary intervention (PCI) is safe and effective in ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS) patients. TRA reduces bleeding and mortality compared to transfemoral access (TFA).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Early revascularization is crucial for ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS).
- Transradial artery access (TRA) for percutaneous coronary intervention (PCI) is increasingly used, showing promise in high-risk patients.
- TRA offers potential benefits over transfemoral artery access (TFA), including reduced bleeding and mortality.
Purpose of the Study:
- To review the literature comparing TRA and TFA for PCI in STEMI and CS patients.
- To summarize the benefits of TRA regarding bleeding, complications, and mortality in these patient groups.
- To discuss technical considerations and challenges associated with TRA in high-risk populations.
Main Methods:
- Systematic review of existing literature, including randomized clinical trials and observational data.
- Analysis of studies comparing TRA versus TFA for PCI in patients with STEMI and CS.
- Evaluation of outcomes such as major bleeding events, peri-procedural complications, and all-cause mortality.
Main Results:
- Randomized trials demonstrate TRA advantages over TFA in STEMI patients, including reduced major bleeding and mortality.
- Observational data suggest similar benefits of TRA compared to TFA in CS patients, despite a lack of dedicated trials.
- TRA is associated with fewer peri-procedural complications and improved survival in both STEMI and CS populations.
Conclusions:
- Transradial access is a safe and effective strategy for PCI in STEMI and CS patients.
- TRA offers significant advantages over TFA, particularly in reducing bleeding and mortality.
- Further research may be warranted to confirm TRA benefits in CS through dedicated randomized trials.
Abstract:
Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.
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