Predictors of a prolonged puncture-wire time in patients with ST-Elevation Myocardial Infarction (STEMI)
Merve Günes-Altan1, Stephan Achenbach2, Johannes Michael Altstidl2
1Department of Cardiology and Angiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Ulmenweg 18, Erlangen, 91054, Germany. merve.guenes-altan@uk-erlangen.de.
Insights
Minimizing delays in ST-elevation myocardial infarction (STEMI) treatment is crucial. Factors like access crossover and lesion complexity impact procedure time, but direct intervention and careful access selection can improve outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Timely reperfusion is critical for ST-elevation myocardial infarction (STEMI) patients.
- Intraprocedural delays in primary percutaneous coronary intervention (PCI) require further investigation.
Purpose of the Study:
- To identify predictors and procedural determinants of prolonged puncture-wire time (PWT) in STEMI patients undergoing primary PCI.
- To inform strategies for minimizing delays in STEMI reperfusion therapy.
Main Methods:
- Retrospective analysis of 1,235 consecutive STEMI patients undergoing primary PCI (2015-2024).
- Defined prolonged PWT as time in the fourth quartile (>17.1 minutes).
- Used multivariable logistic regression to identify independent predictors of prolonged PWT.
Main Results:
- Radial-to-femoral access crossover, arterial kinking/spasm, and challenging culprit lesion revascularization were associated with prolonged PWT.
- Direct intervention of the culprit lesion was associated with shorter PWT.
- Primary vascular access choice (radial vs. femoral) did not significantly impact PWT.
Conclusions:
- Procedural difficulties and access-site decisions influence STEMI reperfusion delays.
- Consider primary femoral access in select cases and prioritize direct culprit lesion intervention to minimize PWT.
Background:
In patients with ST-elevation myocardial infarction (STEMI), rapid reperfusion is essential for optimal outcomes, yet factors influencing intraprocedural delays remain insufficiently investigated.
Methods:
In this single-center retrospective study, consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) between 2015 and 2024 were analyzed. Prolonged time between vascular puncture and wire passage (puncture-wire time; PWT) was defined as a value in the fourth quartile of the study population (>17.1 minutes). Multivariable logistic regression identified independent predictors and procedural determinants of prolonged PWT.
Results:
A total of 1,235 patients (70.7% male, median age 64.5 years [IQR 56.0-75.25]) were included. Radial-to-femoral access crossover (OR 2.539, 95% CI 1.381-4.665, p = 0.003), arterial kinking or severe radial spasm (OR 3.669, 95% CI 1.986-6.778, p < 0.001) and challenging revascularization of the culprit lesion (OR 2.330, 95% CI 1.319-4.116, p = 0.004) were independently associated with prolonged PWT. Direct intervention of the culprit lesion was independently associated with a lower likelihood of prolonged PWT (OR 0.445, 95% CI 0.201 - 0.988, p = 0.047). In contrast, the primary choice of vascular access (radial vs. femoral) was not associated with prolonged PWT (p=0.06).
Conclusion:
While some factors are system- or patient-dependent, early recognition of procedural difficulties and individualized access-site decision making may help minimize procedural delays. In selected patients, a primary femoral access route may be considered, and direct intervention of the culprit lesion should be pursued to minimize PWT.
Clinical Trial Number:
Not applicable.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies