Feasibility of Radial artery access for primary angioplasty and high risk subgroup analysis - A paradigm shift

Abstract

Objective: Radial access (RA) for angioplasty is an established technique, with proven benefits. The paradigm shift has made us to evaluate the feasibility of routine use of radial access in primary percutaneous coronary intervention (PCI). Also high risk subgroups (HRG) analysis was done to identify the clinical and procedure-related variables associated with higher complication rates. Materials and Methods: Total of 315 patients (112 HRG and 203 non HRG) presenting with ST-segment elevation acute myocardial infarction (STEMI) considered for primary PCI through RA at operator discretion were included in the study. The study analyzed the various risk factors and baseline characteristics in whole cohort and subgroup analysis comparing HRG and non HRG. Results: Patient had different spectrum of STEMI, with majority having LV systolic dysfunction. Primary PCI with drug eluting stent was done in majority of patients. Procedural parameters were compared and TIMI- 3 flow was achieved in 86.03%, fluoroscopy time 5-10 min in 90.16% and majority contrast volume used were less than 100 ml. Complications rate was low. Conclusion: This study proved the procedural success of RA for primary PCI in patients with various risk factors and baseline characteristics and supports its routine use for primary PCI. It also showed RA can be used in primary angioplasty in different type of HRG cases without any increase in procedural parameters and complications in comparison with non HRG.