Effect of transradial ECG guided immediate intervention on culprit lesion with a single guiding catheter on door to balloon time

Abstract

Abstract Objective There is limited literature on procedure of primary PCI in catheterization laboratory. This study was designed to assess the impact of electrocardiogram-guided immediate intervention on culprit lesion with a single guiding catheter in ST-elevation myocardial infarction (STEMI) patients on door-to-balloon (D2B) time and clinical outcomes. Methods In this prospective, randomized single center study, 560 patients with STEMI who underwent primary PCI from February 2017 to July 2019 were randomized into two groups. In single catheter group, a single guiding catheter (MAC3.5 or JL 3.5 guiding catheter) was used to perform angiogram and PCI of culprit vessel, followed by contralateral angiography (n=280). In contral group, 280 patients underwent primary PCI after complete diagnostic angiography. The primary evaluation was D2B time and second endpoint include catheterization laboratory-to-balloon (C2B) time, major adverse cardiac events (MACE) at 30 days. This trial was registered with ClinicalTrials.gov, NCT03272451. Results Baseline characteristics were not different between the two groups. The median D2B time (54.83 [IQR 40.00–68.0] min versus 58.32 [IQR 44.12–78.40] min, P=0.007), C2B time (16.91 [IQR 13.88–21.42] min versus 23.80 [IQR 18.92–28.52] min, P<0.001), total procedural time (45.17 [34.06–59.48] min versus 48.51 [37.04–64.60] min, P=0.012) and fluoroscopy time (9.70 [6.50–14.15] min versus 11.26 [8.01–14.27] min, P=0.025)were significantly shorter in single catheter group Compared with control group. The proportion of patients achieving D2B time within 60 minutes increased significantly in the single catheter group (61.79% vs. 52.14%, P=0.021). The rate of radial perforation was significantly reduced in single catheter group (0.71% vs. 3.21%, P=0.033). The total number of catheters was significantly less in single catheter group (1.18±0.54 vs. 2.23±0.60, p<0.001). There was no significant difference in the MACE at 30 days (2.5% vs. 4.64%, P=0.172) between the 2 groups. Conclusion ECG-guided immediate intervention on culprit lesion with a single guiding catheter in STEMI patients can reduce D2B time, C2B time, procedural time and fluoroscopy time. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Capital's Funds for Health Improvement and Research