ECG-guided culprit-first vs. angiography-based revascularization in STEMI: a real-world retrospective study

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.