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ECG-guided culprit-first vs. angiography-based revascularization in STEMI: a real-world retrospective study
Conghui Yan1,2, Linglin Zhang2, Shuang Sha3,4
1School of Clinical Medicine, Shandong Second Medical University, Weifang, China.
Insights
The electrocardiogram (ECG)-guided culprit-first strategy significantly reduced catheterization lab-to-balloon and puncture-to-balloon times in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, overall door-to-balloon time showed no significant difference between strategies.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Technology
Background:
- The single transradial guiding catheter (STGC) technique offers potential benefits in ST-elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI).
- Minimizing catheter exchanges and optimizing reperfusion are key goals in STEMI management.
- Comparing ECG-guided versus angiography-based STGC strategies is crucial for procedural efficiency.
Purpose of the Study:
- To compare the procedural efficiency and clinical outcomes of two STGC strategies in STEMI patients.
- To evaluate the impact of ECG-guided culprit-first intervention versus angiography-based approach on reperfusion times.
- To assess secondary outcomes including procedural success and 30-day major adverse cardiac events (MACE).
Main Methods:
- A retrospective cohort study of 494 STEMI patients undergoing transradial PCI with a 6Fr IL3.5 STGC.
- Patients were divided into ECG-guided (n=128) and angiography-based (n=366) groups.
- Primary endpoints included door-to-balloon (D2B), catheterization lab-to-balloon (C2B), and puncture-to-balloon (P2B) times.
Main Results:
- The ECG-guided group showed significantly shorter C2B (20.96 vs. 23.55 min) and P2B times (13.89 vs. 16.06 min).
- No significant difference in D2B time (50.46 vs. 56.44 min) was observed between groups.
- High procedural success rates (98.43% vs. 99.18%) and comparable TIMI-3 flow were achieved; 30-day MACE rates were similar.
Conclusions:
- The ECG-guided culprit-first strategy using STGC significantly reduces C2B and P2B times in STEMI PCI.
- Despite improved intermediate times, overall D2B time was not significantly affected by the ECG-guided approach.
- Both STGC strategies demonstrate high procedural success and comparable safety profiles.
Background:
The single transradial guiding catheter (STGC) technique has emerged as a promising approach to minimize catheter exchanges and optimize reperfusion timelines in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This study aimed to compare the procedural efficiency and clinical outcomes of two STGC-based strategies: electrocardiogram (ECG)-guided culprit-first intervention and angiography-based group.
Methods:
A retrospective cohort study was conducted on 494 STEMI patients who underwent transradial PCI using a 6Fr IL3.5 (Terumo) STGC at Jiading District Central Hospital between January 2022 and December 2024. Patients were stratified into two groups based on procedural workflow: the ECG-guided group (n = 128) underwent immediate culprit vessel PCI guided by preoperative ECG followed by contralateral angiography, while the angiography-based group (n = 366) received bilateral diagnostic angiography prior to culprit vessel intervention. Primary endpoints included door-to-balloon (D2B), catheterization lab-to-balloon (C2B), and puncture-to-balloon (P2B) times. Secondary endpoints encompassed procedural success rate, 30-day major adverse cardiac events (MACE), and operator preference.
Results:
The ECG-guided group demonstrated significantly shorter median C2B (20.96 vs. 23.55 min, p = 0.01) and P2B times (13.89 vs. 16.06 min, p < 0.01) compared to the angiography-based group. However, there was no statistically significant difference in D2B time between the two groups (50.46 vs. 56.44 min, p = 0.36). Both groups achieved high procedural success rates (98.43% vs. 99.18%, p = 0.68) and comparable post-PCI Thrombolysis In Myocardial Infarction flow grade(TIMI)-3 flow rates (98.44% vs. 99.18%). Culprit vessel distribution differed significantly (p < 0.001), with left anterior descending artery (LAD) predominance in the ECG-guided group (71.88%) and a more balanced distribution between right coronary artery (RCA) and LAD in the angiography-based group. Operator preference strongly influenced strategy selection (p = 0.002), with four operators showing varying inclinations towards angiography-based group (66.67∽87.18%). No significant differences were observed in 30-day MACE (cardiac death, reinfarction, target vessel revascularization) or stroke rates (all p > 0.05).
Conclusions:
In STEMI patients undergoing transradial PCI with an IL3.5 single transradial guiding catheter, the ECG-guided culprit-first strategy was associated with significantly shorter C2B and P2B times compared with the angiography-based approach. However, no significant difference was observed in total D2B time between the two strategies.
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