Arterial access and door-to-balloon times for primary percutaneous coronary intervention in patients presenting with acute ST-elevation myocardial infarction.

Aaron N. Weaver, Rick A. Henderson, Ian C. Gilchrist, Steven M. Ettinger, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, Pennsylvania. Department of Medicine, Section of Cardiology, Wake Forest University, Baptist Medical Center, Winston-Salem, North Carolina.


OBJECTIVES: This study compares the transradial versus the transfemoral approach for time to intervention for patients presenting with ST elevation myocardial infarction (STEMI). Background: Survival following STEMI is associated with reperfusion times (door-to-balloon; D2B). For patients undergoing primary PCI for acute STEMI, potential effects of transradial approach (r-PCI) as compared with the femoral artery approach (f-PCI) on D2B times have not been extensively studied.

METHODS: Consecutive patients presenting with STEMI at a tertiary care medical center were enrolled in a comprehensive – Heart Alert program (HA) and included in this analysis. Time parameters measured included: door-to-ECG, ECG-to-HA activation, HA activation-to-cath lab team arrival, patient arrival in cath lab to arterial access, and arterial access-to-balloon inflation. Results: Of 240 total patients, 205 underwent successful PCI (n = 124 r-PCI; n = 116 f-PCI). No significant difference was observed in the pre-cath lab times. Mean case start times for r-PCI took significantly longer (12.5 ± 5.4 min vs. 10.5 ± 5.7 min, P = 0.005) due to patient preparation. Once arterial access was obtained, balloon inflation occurred faster in the r-PCI group (18.3 vs. 24.1 min; P < 0.001). Total time from patient arrival to the cardiac cath lab to PCI was reduced in the r-PCI as compared to the f-PCI group (28.4 vs. 32.7 min, P = 0.01). There was a small but statistical difference in D2B time (r-PCI 76.4 min vs. f-PCI 86.5 min P = 0.008).

CONCLUSIONS: Patients presenting with STEMI can undergo successful PCI via radial artery approach without compromise in D2B times as compared to femoral artery approach.

Catheterization and Cardiovascular Interventions, Volume 75 Issue 5, Pages 695-699.