Culprit vessel revascularization first with primary use of a dedicated transradial guiding catheter to reduce door to balloon time in primary percutaneous coronary intervention

Guo, Jincheng; Wang, Guozhong; Li, Zixuan; Liu, Zijing; Wang, Yujie; Wang, Senhu; Wang, Yuntao; Wu, Yongxia; Wang, Haotian; Wang, Yuping; Zhang, Libin; Hua, Qi

doi:10.3389/fcvm.2022.1022488

Cited by 3 publications

(1 citation statement)

References 43 publications

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“… 11 , 12 , 13 , 14 Another prospective study with short-term follow-up showed that using a single transradial guiding catheter in conjunction with culprit lesion PCI before CAG reduced the door-to-balloon time. 15 The present study aimed to prospectively evaluate the effect of culprit lesion PCI before complete diagnostic CAG on reperfusion time, in-hospital outcomes, and long-term outcomes among patients with STEMI who undergo primary PCI.…”

Section: Introductionmentioning

confidence: 99%

Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction

Levi,

Wolff,

Jubeh

et al. 2024

JAMA Netw Open

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ImportanceRapid reperfusion during primary percutaneous coronary intervention (PCI) is associated with improved outcomes among patients with ST-elevation myocardial infarction (STEMI). Although attempts at reducing the time from STEMI diagnosis to arrival at the catheterization laboratory have been widely investigated, intraprocedural strategies aimed at reducing the time to reperfusion are lacking.ObjectiveTo evaluate the effect of culprit lesion PCI before complete diagnostic coronary angiography (CAG) vs complete CAG followed by culprit lesion PCI on reperfusion times among patients with STEMI.Design, Setting, and ParticipantsThis open-label, prospective, randomized clinical trial was conducted between April 1, 2021, and August 31, 2022, among patients admitted to a tertiary center in Jerusalem, Israel, with a diagnosis of STEMI undergoing primary PCI. All patients were followed up for 1 year. Analysis was on an intention-to-treat basis.InterventionPatients were randomized in a 1:1 ratio to undergo either culprit lesion PCI before complete CAG or complete CAG followed by culprit lesion PCI.Main Outcomes and MeasuresA needle-to-balloon time of 10 minutes or less.ResultsA total of 216 patients were randomized, with 184 patients (mean [SD] age, 62.9 [12.2] years; 155 men [84.2%]) included in the final intention-to-treat analysis; 90 patients (48.9%) were randomized to undergo culprit lesion PCI before CAG, and 94 (51.1%) were randomized to undergo to CAG followed by PCI. Patients who underwent culprit lesion PCI before complete CAG had a shorter mean (SD) needle-to-balloon time (11.4 [5.9] vs 17.3 [13.3] minutes; P &lt; .001). The primary outcome of a needle-to-balloon time of 10 minutes or less was achieved for 51.1% of patients (46 of 90) who underwent culprit lesion PCI before CAG and for 19.1% of patients (18 of 94) who underwent complete CAG followed by culprit lesion PCI (odds ratio, 4.4 [95% CI, 2.2-9.1]; P &lt; .001). Rates of adverse events were similar between groups. In a subgroup analysis, the effect of culprit lesion PCI before complete CAG on the primary outcome was consistent. There were no differences in rates of in-hospital, 30-day, and 1-year all-cause mortality.Conclusions and RelevanceIn this randomized clinical trial of patients with STEMI, culprit lesion PCI before complete CAG resulted in shorter reperfusion times. Larger trials are needed to validate these results and to evaluate the effect on clinical outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT05415085

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Section: Introductionmentioning

confidence: 99%

Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction

Levi,

Wolff,

Jubeh

et al. 2024

JAMA Netw Open

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Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI

Savage,

Hay,

Vollbon

et al. 2024

Cathet Cardio Intervent

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BackgroundHistorically, differences in timely reperfusion and outcomes have been described in females who suffer ST‐segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies.MethodsComparisons between sexes were performed on STEMI patients treated with primary PCI over a 4‐year period (January 1, 2017–December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30‐day and 1‐year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models.ResultsOverall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; p < 0.001), had longer total ischemic time (69 min vs. 52 min; p < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; p < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8–2.2; p = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7–2.1; p = 0.58) effect of female sex on 30‐day mortality. One‐year mortality was higher in females (6.9% vs. 4.4%; p = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0–2.3; p = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9–4.7; p = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6–1.6; p = 0.94) indicated sex differences were explained by confounders and mediators.ConclusionSmall sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.

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Culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Bulhões,

Antunes,

Defante

et al. 2024

Coronary Artery Disease

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The rapid restoration of blood flow in patients with acute myocardial infarction with ST elevation through percutaneous coronary intervention (PCI) is crucial for the survival of this population. Attempts to decrease the time from diagnosis of ST-segment elevation myocardial infarction (STEMI) to arrival at the catheterization laboratory have been extensively investigated. However, strategies during the procedure aiming to reduce the time to reperfusion are lacking. We conducted a meta-analysis to evaluate culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary PCI for patients with STEMI. We searched PubMed, Embase, and Cochrane Central. Outcomes: vascular access-to-balloon, door-to-balloon, and first medical contact-to-balloon times; death, reinfarction in 30 days, Bleeding Academic Research Consortium ≥3 type, coronary artery bypass grafting referral, and left ventricular ejection fraction %. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I 2 statistics. We included 2050 patients from six studies, of which two were randomized controlled trials and four were observational studies. Culprit vessel revascularization prior to complete angiography was associated with a statistically significant decrease of times: vascular access-to-balloon time (mean difference −6.79 min; 95% CI: −8.00 to −5.58; P < 0.01; I 2 = 82%) and door-to-balloon time (mean difference −9.02 min; 95% CI: −12.83 to −5.22; P < 0.01; I 2 = 93%). In this meta-analysis, performing PCI on the culprit lesion prior to complete coronary angiography led to significantly shorter reperfusion times, with no discernible differences in complication rates.

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Culprit vessel revascularization first with primary use of a dedicated transradial guiding catheter to reduce door to balloon time in primary percutaneous coronary intervention

Cited by 3 publications

References 43 publications

Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction

Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction

Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI

Culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

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