Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach

Abstract

The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3h from symptoms onset) or late (>3h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12h from symptoms onset or 12-24h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm. Patients who were taken to a non-PCI capable hospital received streptokinase and were then transferred to our Hospital for CA. TRA was used in the catheterization laboratory for all patients. Each arm was divided according to reperfusion time into early and late subgroups. A primary endpoint was death, shock, congestive heart failure, or reinfarction up to 30days. There was a non-significant difference regarding LVEF in both arms. Myocardium wall preservation was significant in the early PI arm (P=0.023). TIMI flow had no discrepancy between both arms (P=0.569). Mean procedural and fluoroscopic time were 35.1±6.1 and 6.3±0.9min. There were no reported entry site complications. There was no difference in primary endpoint complications (P=0.326) considering the different times of patients' reperfusion (early; P=0.696vs. late; P=0.424). In conclusion, it is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI. We recommend PI for STEMI patients with delay presentation if PPCI is not available.