Author + information
- Ashish Shah1,
- Richard A. Anderson1,
- Rito Mitra2,
- Anirban Choudhury1,
- Nick Ossei-Gerning1,
- William Penny1 and
- Timothy D. Kinnaird1
Performing percutaneous coronary intervention (PCI) through radial access has been demonstrated to be beneficial. Primary PCI (PPCI) is the standard of care in those presenting with ST elevation myocardial infarction (STEMI). Emerging data does suggest that performing PPCI through radial access reduces morbidity and mortality, but still many centres perform PPCI through femoral access, as there is concern that radial access may result in longer procedural time, especially in those with cardiogenic shock and has some chance of access failure, requiring femoral access.
Methods and Results
We are one of the tertiary cardiac hospitals in the Wales, UK and a default radial centre. Since beginning of the 24/7 STEMI program from early 2012, in the first 18 months we have performed PPCI in 773 patients, with age ranging from 25 to 101 years. Ninety two patients presented in cardiogenic shock. Out of all patients, 94.6% patients underwent PPCI through radial access (96.9% in patients without cardiogenic shock and 77.8% in those with cardiogenic shock). Patients requiring IABP insertion, the procedure was counted as through femoral access.
For all patients, mean door to balloon time of 49.8 minutes (door to cath-lab time of 23.8 minutes and cath-lab to balloon time of 25.9 minutes) and call to balloon time of 115.1 minutes was achieved. There was no significant difference in door to balloon time between those with / without cardiogenic shock, but call to balloon time was significantly high in those presenting in cardiogenic shock.
In-hospital mortality was 1.5% in those without cardiogenic shock and 23.9% in those with cardiogenic shock. None of the patients who underwent PPCI through radial access had any bleeding complication. Main factors requiring femoral vascular access in our centre were; poor radial access, cardiogenic shock and previous bypass surgery, even though majority of those with previous CABG underwent PPCI through left radial access.
Radial access for performing PPCI is safe and effective, even in majority of those presenting with cardiogenic shock or previous CABG. Door to balloon time is well within recommendation period as per the guidelines. Bleeding complication is markedly reduced. Radial access should be the default route to perform PPCI.