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Benefit of routine preprocedural radial artery angiography in STEMI patients
Biljana Zafirovska1, Slobodan Antov1, Jorgo Kostov1
1University Clinic of Cardiology, Skopje, Macedonia.
Insights
Routine preprocedural radial artery angiography in ST-segment elevation myocardial infarction (STEMI) patients significantly reduces bleeding complications and procedural crossover rates. This practice also leads to shorter procedure times, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Imaging
Background:
- ST-segment elevation myocardial infarction (STEMI) requires prompt intervention.
- Transradial approach (TRA) is a common method for percutaneous coronary intervention (PCI) in STEMI.
- Optimizing TRA success and minimizing complications is crucial for patient care.
Purpose of the Study:
- To evaluate the impact of routine preprocedural radial artery (RA) angiography on STEMI patients undergoing PCI.
- To assess changes in access site bleeding complications and TRA failure rates.
- To determine if routine RA angiography improves procedural efficiency.
Main Methods:
- Retrospective comparison of STEMI patients before and after the implementation of routine preprocedural RA angiography (March 2011).
- Analysis of clinical characteristics, procedural data, bleeding complications, and TRA crossover rates.
- Comparison between a group of 762 patients (2010-2011) and 4306 patients (2011-2016).
Main Results:
- The group with routine RA angiography had more elderly and obese patients.
- Access site bleeding complications decreased from 6.8% to 4.3% (p<0.0001).
- TRA crossover rate significantly reduced from 4.6% to 3.1% (p<0.0001), with a decrease in procedure duration.
Conclusions:
- Routine preprocedural RA angiography in STEMI patients is beneficial.
- This practice is associated with a lower incidence of access site bleeding.
- It also leads to reduced TRA crossover rates and overall procedural time.
Aims:
To assess the benefit of routine preprocedural radial artery (RA) angiography in patients with ST segment elevation myocardial infarction (STEMI).
Methods And Results:
All consecutive STEMI patients, in the period from January 2010 until December 2016 were included in the study. Preprocedural radial artery angiography was performed in all patients since March 2011. We compared clinical and procedure characteristics, access site bleeding complications and failure of primary chosen TRA between two groups of STEMI patients before and after we started performing routine RA angiography. We compared 762 STEMI patients from 2010 until March 2011 and 4306 STEMI patients after March 2011 until December 2016. Mean age of patients was 60 ± 11 years with 73% males. The latter group had more elderly and obese patients (P < .0001 both). Prior percutaneous coronary interventions was present in 7% of patients and 0, 1% had prior coronary bypass surgery. Procedure duration (38 ± 16 vs. 32 ± 20 min) was significantly longer in the first group (P value < .0001), but contrast volume (120 ± 33 vs. 110 ± 35 ml), and fluoroscopy time (8.6 ± 6 vs. 8.7 ± 8 min) were similar in both groups. Access crossover from primary TRA was 4, 6% in the first group, with a significant decrease to 3, 1% in the second (P < .0001), after introducing preprocedural RA angiography. Access site bleeding complications were significantly higher in the first group 6.8% vs. 4.3% in the second (p < .0001).
Conclusion:
Routine preprocedural radial artery angiography in STEMI patients is associated with lower rate of access site bleeding complications and reduced overall procedural time and TRA crossover rate.
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