Randomized Trial Comparing Radial and Ulnar Access in Single-Catheter Primary Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Acute ST elevation myocardial infarction (STEMI) necessitates timely percutaneous coronary interventions (PCIs).
• Transradial and transulnar arterial access are common routes for PCI procedures.
• Evaluating the comparative effectiveness of these access routes is crucial for optimizing patient care.

Purpose of the Study:

• To compare procedural success, complication rates, and clinical outcomes between transradial and transulnar arterial access in primary PCI for STEMI.
• To assess the effectiveness of a single-catheter approach for both radial and ulnar arterial interventions.

Main Methods:

• A randomized controlled study included 231 patients with STEMI undergoing primary PCI.
• Patients were allocated to either transradial (Group R, n=113) or transulnar (Group U, n=118) access.
• Key outcomes prospectively compared included procedural success, arterial punctures, procedure duration, and complications.

Main Results:

• Procedural success rates were comparable between transradial and transulnar groups.
• Transulnar access demonstrated a significantly higher number of arterial punctures (40.7% vs 21.2%) and longer puncture duration (p=0.001).
• No significant differences were found in post-procedural hematoma or arterial occlusion rates.

Conclusions:

• Transulnar arterial access is a viable alternative to transradial access for primary PCI in STEMI patients, offering similar success and safety.
• Transulnar access is associated with increased puncture attempts and duration.
• Consider transulnar access when transradial access is technically challenging or not feasible.