Benefit of routine preprocedural radial artery angiography in STEMI patients

Zafirovska, Biljana; Antov, Slobodan; Kostov, Jorgo; Spiroski, Igor; Vasilev, I; Jovkovski, Aleksandar; Kitanoski, Darko; Petkoska, Danica; Bertrand, Olivier; Kedev, Saško

doi:10.1002/ccd.27711

Cited by 17 publications

(18 citation statements)

References 21 publications

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“…Our hospital is a high volume transradial center (80% of all PCI interventions in the country) and the main referral center for primary PCI and complex procedures. Transradial approach has been the default approach in our center since 2008 21 , which is in accordance with the ESC guidelines for treatment of PCI patients [22][23][24] , and most probably has contributed to the low MACCE and mortality in our results [7][8][9] .…”

Section: Discussionsupporting

confidence: 71%

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Risk Factor Distribution and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention in Macedonia

Zafirovska

Otljanska

Petkoska

et al. 2019

ACC

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The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.

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Section: Discussionsupporting

confidence: 71%

“…Pre-procedural retrograde radial arteriography was performed in all patients to define the radial artery anatomy from mid forearm to ulnobrachial anastomosis and to delineate ulnar artery anatomy as well, thus generating the access roadmap [6][7][8][9][10] .…”

Section: Methodsmentioning

confidence: 99%

Risk Factor Distribution and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention in Macedonia

Zafirovska

Otljanska

Petkoska

et al. 2019

ACC

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“…Thus, for the routine use of radial artery angiograms and roadmaps, we advocate identifying radial artery tortuosity prior to wire passage. A recent study found that routine preprocedural radial artery angiography is associated with a lower rate of access site bleeding complications, reduced overall procedural time, and TRA crossover rate 30…”

Section: Radial Artery Anomalies and Tortuositymentioning

confidence: 99%

Transradial access for neurointerventions: management of access challenges and complications

Brunet

Chen

Peterson

2019

J NeuroIntervent Surg

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BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

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“…In the present study, trans-radial access and the use of mechanical support were significantly associated with MACE. Previous studies showed that trans-radial primary PCI was associated with less bleeding and long-term clinical outcomes [32][33][34]. However, we should mention the presence of selection bias regarding the access site.…”

Section: Plos Onementioning

confidence: 88%

Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes

et al. 2020

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Background Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the doorto-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. Methods This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of allcause death, acute myocardial infarction, and acute heart failure requiring hospitalization. Result The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m 2) (vs. >20 kg/ m 2 : HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE. Conclusion Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas

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Benefit of routine preprocedural radial artery angiography in STEMI patients

Abstract: Routine preprocedural radial artery angiography in STEMI patients is associated with lower rate of access site bleeding complications and reduced overall procedural time and TRA crossover rate.

Cited by 17 publications

References 21 publications

Risk Factor Distribution and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention in Macedonia

Risk Factor Distribution and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention in Macedonia

Transradial access for neurointerventions: management of access challenges and complications

Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes

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