Author + information
- Ashish Shah1,
- Richard A. Anderson1,
- Rito Mitra2,
- Nick Ossei-Gerning1,
- William J. Penny1,
- Anirban Choudhury1 and
- Timothy D. Kinnaird1
Primary PCI is the standard of care for those presenting with STEMI. Trans-radial (TR) vascular access to perform PCI is superior to trans-femoral (TF) access, mainly due to reduced bleeding, leading to overall mortality benefit; patient satisfaction remains very high. Limited skills, concerns with prolonged procedure time, difficult vascular anatomy, presence of cardiogenic shock (CS), previous CABG and abnormal Allen's test are limiting factors.
We are one of the tertiary cardiac centres in UK, and a default radial centre. Since beginning of the 24/7 STEMI program, we have performed PPCI in 773 patients, age ranging from 25 to 101 years. Ninety two patients presented in CS. We did not perform Allen's test in any patients, presence of pulse was enough to proceed. We assessed in-hospital complications.
Out of all patients, 94.6% patients underwent PPCI through TR-TU vascular access (96.9% in those without CS and 77.8% of those with CS). We failed to proceed TR only in 2 patients. Three patients had occluded radial artery after previous procedure, in whom we performed PCI through TU approach in same arm. Total of 8 patients had procedure performed through TU access .
For all patients, mean door to balloon time was 49.8 minutes (door to cathlab: 23.8 mins and cath-lab to balloon time: 25.9 mins); call to balloon time was 115.1 mins, without any significant difference between those with / without CS. Contrast volume, radiation dose and fluoroscopy time were no different between groups.
In-hospital mortality was 1.5% in those without cardiogenic shock and 23.9% in those with cardiogenic shock. None of the patients who had PPCI through TR-TU access had any vascular complication. Only 6 patients who had PPCI through TF had localized bleeding, without need for blood transfusion.
1. Performing PPCI through TR-TU access is safe, even in those with CS, previous CABG and occluded radial artery after previous PCI.
2. Allen's test is not a prerequisite, and should not be a limiting factor.
3. Once operators are well trained, majority of patients can have intervention performed through TR-TU access without any time delay in completion of successful intervention.