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Applicability of left distal radial artery access site in ST-segment elevation myocardial infarction; A comparative
1Department of Cardiology, Ege University Medical School, Izmir, Turkey.
Insights
The left distal radial artery (LDRA) is a viable alternative to the transfemoral (TF) approach for primary percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI) patients, offering reduced hospital stays and complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The left distal radial artery (LDRA) is increasingly used for coronary angiography.
- Its utility in primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) remains less understood.
- This study compares LDRA with the traditional transfemoral (TF) approach in STEMI patients undergoing PPCI.
Purpose of the Study:
- To evaluate the convenience and outcomes of using the LDRA for PPCI in STEMI patients.
- To compare the LDRA approach with the TF approach in terms of procedural success, complications, and resource utilization.
Main Methods:
- A retrospective analysis of 91 consecutive STEMI patients undergoing PPCI.
- Operators chose the access site (LDRA or TF) independently.
- Demographic data, clinical outcomes, procedural times, radiation exposure, and hospital duration were recorded.
Main Results:
- Successful PPCI rates were high and similar between LDRA (90%) and TF (91.8%) groups.
- The LDRA group experienced significantly lower fluoroscopy time, radiation exposure, and hospital duration.
- In-hospital mortality was higher in the TF group (18%) compared to the LDRA group (0%).
Conclusions:
- LDRA is a convenient and safe alternative access site for PPCI in STEMI patients.
- The LDRA approach is associated with reduced hospital duration and complication rates compared to the TF approach.
- Further research may support wider adoption of LDRA in acute STEMI management.
Background:
Left distal radial artery (LDRA) has got high popularity as an alternative safe access site in coronary angiography. However, little is known about its applicability in primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients. We aimed to assess the convenience of LDRA access in STEMI patients and make the comparative evaluation with the transfemoral (TF) route.
Materials And Methods:
A total of 91 consecutive STEMI patients who underwent PPCI from January to June 2019, were analyzed. Experienced operators, unaware of the study were left free of access site decision. Comparative demographic features and clinical outcomes were recorded during hospitalization.
Results:
LDRA was used in 30 patients, whereas 61 patients underwent a TF approach. Successful PPCI was achieved in high rates in both groups (LDR: 90% vs TF: 91.8%: p = 0.795). On admission, KILLIP (II, III) class was higher in the LDRA group (23.3% vs 3.4%), whereas stent thrombosis, arhythmias were higher in the TF group (0% vs 6.6% p = 0.151; 6.7% vs 18% p = 0.355 respectively). Puncture time was relatively similar between groups (28.63 vs 28.93 s p = 0.767). Fluoroscopy time, total radiation exposure and hospital duration was found lower in the LDRA group (10.11 vs 13.75 min p < 0.001; 917.87 vs 1940.91 mGy p < 0.001; 4.2 vs 6.2 days p = 0.024 respectively). In-hospital mortality was found higher in the TF group (0% vs 18% p = 0.013).
Conclusion:
In the acute management of STEMI, LDRA access site can be a convenient alternative to TF approach with shorter hospital duration and complication rates.
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