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Feasibility and effectiveness of distal radial access in ST-elevation myocardial infarction from a SPEEDY PCI
Akihiko Takahashi1,2,3, Sho Torii4, Yujiro Ono5
1Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Sumaku, Kobe, 654-0026, Japan. a-takahashi@wine.ocn.ne.jp.
Insights
The distal radial approach (dTRA) is a safe and feasible option for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). This approach may lead to faster procedures, though institutional factors also play a role.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The distal radial approach (dTRA) is an emerging alternative to the conventional radial artery access for coronary interventions.
- Its application in ST-elevation myocardial infarction (STEMI), a time-sensitive condition requiring rapid revascularization, is not well-established.
Purpose of the Study:
- To assess the feasibility and procedural outcomes of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- To compare dTRA with the conventional radial approach in this critical patient population.
Main Methods:
- A prespecified subanalysis of the SPEEDY PCI study included 370 STEMI patients.
- 63 patients underwent PCI via dTRA, and 307 via the conventional radial approach.
- Propensity score matching was used to adjust for baseline characteristics, including Killip class, GRACE score, and door-to-sheath time.
Main Results:
- After matching, the dTRA group demonstrated significantly shorter sheath-to-balloon times (12.5 vs. 19.7 minutes, p=0.002) and door-to-balloon times (50.2 vs. 62.3 minutes, p=0.007).
- Procedural success rates and 30-day mortality were similar between the dTRA and conventional radial approach groups.
Conclusions:
- dTRA is a feasible and safe vascular access method for STEMI patients, particularly in high-volume centers.
- Observed reductions in procedure times with dTRA may be influenced by institutional practices and operator experience in addition to the access site itself.
Abstract:
The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)-where rapid revascularization is critical-remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score-matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7 min, p = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9 min, p = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.
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