Association of adoption of transradial access for percutaneous coronary intervention in ST elevation myocardial infarction with door‐to‐balloon time

Huded, Chetan; Kapadia, Samir; Ballout, Jad; Krishnaswamy, Amar; Ellis, Stephen G.; Raymond, Russell; Cho, Leslie; Simpfendorfer, Conrad; Bajzer, Chris; Martin, Joseph; Nair, Ravi; Lincoff, A. Michael; Kravitz, Kathleen; Menon, Venu; Hantz, Scott; Khot, Umesh N.

doi:10.1002/ccd.28785

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Our study was concordant with major observational registry in USA of 546 patients with STEMI treated with PPCI endorsed by Huded et al (9) which found that TR-PPCI can be successfully implemented without compromising D2BT performance concluding that the purposeful transition of low-percentage TR-PPCI hospitals and operators into high-percentage TR-PPCI hospitals and operators can be achieved without sacrificing D2BT gains, offering the potential to improve STEMI outcomes at the population level if widely embraced.…”

Section: Thissupporting

confidence: 90%

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Zahran,

El Rabat,

Abd El Rahman

et al. 2023

Benha Medical Journal

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Background: Access-site bleeding is the most frequent bleeding complication of transfemoral primary percutaneous coronary intervention (TF-PPCI). In contrast, transradial PPCI (TR-PPCI) has been demonstrated in multiple trials to be safer than the femoral approach due to the lower risk of significant bleeding. This study's objective was to study adoption of TR-PPCI for STEMI and its association with door-to-balloon time (D2BT). Methods: This study was carried out on 70 patients diagnosed as STEMI treated with PPCI were compared according to the access site used during the procedure. Patients were divided into 2 equal groups, group I: STEMI patients treated with TR-PPCI, and group II: STEMI patients treated with TF-PPCI. Patients were subjected to physical examination, risk assessment, electrocardiogram (ECG), transthoracic echocardiography, and coronary angioplasty. Results: D2BT was 107 min in TF-PPCI compared to 114 min in TF-PPCI group with no statistically significant difference. BMI and presence of prior peripheral arterial disease were significantly higher in TR-PPCI group compared to TF-PPCI group. Presence of cardiogenic shock and cardiac arrest within prior 24 h, and mean contrast volume were significantly lower in TR-PPCI group compared to TF-PPCI group (p ≤ 0.05). Clinical data, ECG, laboratory data, patients' presenting location, time in minutes, procedural medications, angiographic data, thrombus aspiration device, balloon angioplasty, direct stenting, number and type of stents, TIMI pre and post, and complications were insignificantly different between the studied groups. Conclusions: TR-PPCI can be successfully implemented without compromising D2BT performance offering the potential to improve STEMI outcomes if widely embraced.

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Section: Thissupporting

confidence: 90%

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Zahran,

El Rabat,

Abd El Rahman

et al. 2023

Benha Medical Journal

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“…On the other hand, Rubartelli et al [14] mentioned that crossover was associated with a much longer door-to-balloon median time 75 minutes vs. 43 minutes in comparison to successful transradial PCI in STEMI patients. Huded et al showed in their report that vascular crossovers do not compromise door-to-balloon time performance though [17].…”

Section: Resultsmentioning

confidence: 99%

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Piątek

Kurzawski

et al. 2022

Kardiol Pol

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Background:The radial artery became preferable access for percutaneous coronary interventions (PCI). The latest European Society of Cardiology guidelines strongly recommended transradial access in patients with ST-segment elevation myocardial infarction (STEMI). Though, in a significant portion of the coronary artery, invasive procedure crossover to femoral is necessary.Aims: This study aimed to determine the ratio, risk factors, and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry. Methods:Based on data from the Polish registry ORPKI, we analyzed 90245 patients with a diagnosis of STEMI that were intended to be treated invasively via transradial access between 2014 and 2019. Results:In 1484 (1.6 %) individuals, a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were female sex, previous coronary artery bypass graft, class 3 and 4 of the Killip scale, left main disease, as well as any complications during coronary angiography. In that cohort, the risk of bleeding at the puncture site was over 20--fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, Thrombolysis In Myocardial Infarction (TIMI) after PCI, and no-reflow) between these groups resulted from disparities in initial characteristics, and they were not associated with crossover itself. Conclusions:Even though the risk of crossover to femoral is currently low, it appears to be indispensable to sustain operators' experience both in radial and femoral approaches to achieve the best outcomes in these patients.

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“…12 Other studies have shown the number of BAS may be observed less as a patient’s age increases, a population that is likely to benefit the most. 13 Additional studies have proven the effectiveness of known BAS strategies 12,14,15 and a lack of correlation between clinical bleeding and transfusion practices. 5 Notably, the campaign produced a single resource for known BAS strategies.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Multidimensional Strategy to Reduce Post-PCI Bleeding Risk

Price,

Amin,

Rogers

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: The American College of Cardiology Reduce the Risk: PCI Bleed Campaign was a hospital-based quality improvement campaign designed to reduce post-percutaneous coronary intervention (PCI) bleeding events. The aim of the campaign was to provide actionable evidence-based tools for participants to review, adapt, and adopt, depending upon hospital resources and engagement. METHODS: We used data from 8 757 737 procedures in the National Cardiovascular Data Registry between 2015 and 2021 to compare patient and hospital characteristics and bleeding outcomes among campaign participants (n=195 hospitals) and noncampaign participants (n=1384). Post-PCI bleeding risk was compared before and after campaign participation. Multivariable hierarchical logistic regression was used to determine the adjusted association between campaign participation and post-PCI bleeding events. Prespecified subgroups were examined. RESULTS: Campaign hospitals were more often higher volume teaching facilities located in urban or suburban locations. After adjustment, campaign participation was associated with a significant reduction in the rate of bleeding (bleeding: adjusted odds ratio, 0.61 [95% CI, 0.53–0.71]). Campaign hospitals had a greater decrease in bleeding events than noncampaign hospitals. In a subgroup analysis, the reduction in bleeding was noted in non–ST-segment–elevation acute coronary syndrome and ST-segment–elevation myocardial infarction patients, but no significant reduction was seen in patients without acute coronary syndrome. CONCLUSIONS: Participation in the American College of Cardiology Reduce the Risk: PCI Bleed Campaign was associated with a significant reduction in post-PCI bleeding. Our results underscore that national quality improvement efforts can be associated with a significant impact on PCI outcomes.

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Association of adoption of transradial access for percutaneous coronary intervention in ST elevation myocardial infarction with door‐to‐balloon time

Abstract: Objectives: We aimed to study adoption of transradial primary percutaneous coronary intervention (TR-PPCI) for ST elevation myocardial infarction (STEMI) ("radial first" approach) and its association with door-to-balloon time (D2BT).

Cited by 6 publications

References 31 publications

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Adoption of Transradial Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction and Its Association with Door-To-Balloon Time

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from the Polish ORPKI registry

Implementation of a Multidimensional Strategy to Reduce Post-PCI Bleeding Risk

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