Door-to-balloon time in radial versus femoral approach for primary angioplasty in patients with st-segment elevation myocardial infarction

Abstract

Primary percutaneous coronary intervention (pPCI) is considered the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction (STEMI), conditional on the timely performance of the PCI procedure, as survival directly relates to reperfusion times. For patients undergoing pPCI for acute STEMI, potential differences between radial PCI (r-PCI) and femoral PCI (f-PCI) in door-to-balloon (D2B) times have not been widely evaluated. This study compares the D2B time between transradial versus the transfemoral approach in patients presenting with STEMI. A retrospectively collected catheterization laboratory database was reviewed for the consecutive patients presenting with a STEMI, who underwent pPCI by the authors over a 23 months period at a tertiary care hospital(Cardiothoracic department, Spedali Civili, Brescia University, Italy). The study population was divided according to arterial access used to perform pPCI into 2 groups; radial group and femoral group. Specific time parameters were recorded: time from emergency room arrival–to-patient arrival in catheter laboratory, time from patient arrival in catheter laboratory–to-balloon inflation and total D2B time. Our composite end point was the time to revascularization, angiographic success, short term clinical success, and procedural vascular complications. Radial PCI were performed in 33 patients (67.3%) and 16 patients (32.7%) done through femoral artery. There was no statistical significant difference between the two groups regarding all demographic data. No significant difference was observed in the pre-catheter and catheter laboratory times. Mean times from emergency room door-to-catheter laboratory time for r-PCI vs. f-PCI were 82.48 ± 37.42 and 76.29 ± 34.32 minutes respectively ( P = 0.636). The mean time from patient arrival to the cardiac catheter laboratory-to-balloon inflation was 34.56 ± 14.2 in the r-PCI group vs. 33.12 ± 12.56 min with the f-PCI group ( P = 0.215). The total D2B time was not significantly different between r-PCI vs. f-PCI groups (100.32 ± 36.3 vs. 97.31 ± 30.37 min respectively, P = 0.522). Angiographic success rates were observed in 92.1% of the patients for r-PCI, and in 87.5% for f-PCI ( P = 0.712). Patients presenting with STEMI can undergo successful pPCI via radial artery without compromising patient care. Door to balloon time is not increased by radial artery access compared with femoral artery access, where the operator has a considerable experience using the radial artery for coronary intervention.