Abstract 16630: Transradial Approach in Acute Myocardial Infarction in the Real Life (TRAP-AMI): a Prospective Registry
Background: There is growing evidence that transradial (TR) as compared to transfemoral (TF) percutaneous coronary intervention (PCI) is associated with improved clinical outcome driven by less hemorrhagic complications, in particular in STEMI patients receiving aggressive antithrombotic treatment. Feasibility rate of TR-PCI in STEMI patients has not yet been evaluated.
Methods/Results: Four-hundred thirty six consecutive STEMI patients (<12h) without cardiogenic shock were prospectively enrolled in this single-center cohort. The radial access was chosen whenever radial pulse was suggestive of prompt puncture success. In case of puncture failure the operator switched immediately to TF-PCI. The mean age of patients was 62±14 (range 27–94) years. Seventy-three percent were men, 17% had diabetes, 13% had known coronary artery disease, and 1.4% had coronary artery bypass grafts (CABG). Five percent of patients had pre-hospital thrombolysis. PCI was performed using 6F (99%) and 5F (1%) guiding catheters. Glycoprotein inhibitors were used in 74%, and thrombectomy was performed in 67% of patients. Procedural success rate was 97.7% (TIMI flow ≥ 2 and < 50% residual stenosis). The feasibility rate of TR-PCI was 89.2%. The femoral access was chosen primarily without TR attempt in 6.4 % (n=28) of patients due to weak or absent radial pulse (n=19), severe bradycardia (n=3), prior TR failure (n=4), dialysis (n=1), or recent radial puncture (n=1). The femoral access was chosen secondarily to TR failure in 4.4 % (n=19) of patients following radial puncture failure (n=14), dissection of the radial artery (n=1), severe tortuosities or stenosis of the upper limb axis (n=2), or non-selective position of the guiding catheter (n=2). After beginning of PCI, switch from TR to TF was not necessary in any patient. Door-to-balloon time in patients with secondary TF-PCI was 45±11min, as compared to 33±13min for TR-PCI and 37±13 min for primary TF-PCI. Female sex was associated with TR failure (p=0.02).
Conclusion: In STEMI patients without cardiogenic shock, PCI can be performed via the radial artery in nearby 90% of cases with high procedural success rate. TR failure is significantly more common in women. Good quality radial pulse is predictive of successful TR-PCI in 96% of cases.
- Myocardial infarction, STEMI
- Myocardial revascularization
- Percutaneous coronary intervention
- Interventional cardiology
- © 2010 by American Heart Association, Inc.