Abstract 12696: Transradial Approach to STEMI Intervention at Ohio State University: Clinical Results of a Protocol to Minimize Transradial D2B times
Door to Balloon time (D2B) in PCI in STEMI is a major driver of clinical outcomes, with shorter D2B resulting in superior cardiac outcomes and long term survival. Cardiologists may be hesitant to perform PCI in STEMI patients from the radial artery due to prolonged procedure times with transradial vs transfemoral. We hypothesized that if transradial and transfemoral D2B times were equal, a transradial approach could have superior outcomes in STEMI patients because of lower major bleeding complications and the ability to use stronger antithrombotic regimens. We developed a protocol with a "3 minute rule": STEMI patients have both the wrist and groin prepped simultaneously, and a timer is started when the patient is fully draped. The primary operator (usually the attending) attempts to access the radial artery while the second operator (usually the fellow) is prepared to access the femoral artery. If the radial artery sheath is not in place at 3 minutes, the second operator accesses the femoral artery and the radial site is abandoned. Using this approach in 413 consecutive STEMI cases from 7/2009 through 2/2012 we have achieved cath lab arrival to reperfusion times that are near equivalent (transradial=27 min, transfemoral=25 min), and a remarkable reduction in major complications in transradial STEMI vs transfemoral STEMI cases. Specifically, major reductions (unadjusted) in in-hospital death ( 11% vs 1%), blood transfusions (15% vs 5%), and major access site complications (6% vs 0%) were achieved. Thus, with a protocol to minimize transradial D2B times in STEMI patients, we achieved marked reductions in major complications compared to a conventional transfemoral approach. These results can inform other centers that are performing elective transradial PCI but are hesitant to treat STEMI patients via the radial artery.
- © 2012 by American Heart Association, Inc.