Gabric ID - AIMRADIAL 2013 - Radial in STEMI
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The study evaluates the effectiveness and safety of radial versus femoral access in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It concludes that there is no significant difference in procedure success, safety, or blood loss between the two access methods, regardless of whether an operator used left or right radial access. Data from 767 patients treated between 2011 and 2013 were analyzed to support these findings.
Gabric ID - AIMRADIAL 2013 - Radial in STEMI
- 1. Gabrić ID, Pintarić H, Babić Z, Trbušić M, Krčmar T, Nikolić-Heitzler V, Manola Š, Radeljić V, Zeljković I University Hospital Center Sestre milosrdnice Zagreb, Croatia
- 2. Dr. Ivo Darko Gabrić has no relevant financial interests to disclose
- 5. Croatian PPCI Network 2005 -2013
- 7. 1800 1600 1400 1200 pPCI elective PCI Diagnostic 1000 800 600 400 200 0 2006 2007 2008 2009 2010 2011 2012
- 8. 100.0% + ulnar + brachial 90.0% 80.0% 70.0% 60.0% Diagnostic Elective PCI pPCI 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2008 2009 2010 2011 2012 2013
- 10. SCAAR (Swedish Coronary Angiography and Angioplasty Register) Transradial PCI cuts mortality in STEMI Chodor et all (2011) RADIAMI II The TRA pPCI in pts with STEMI longer door to balloon time no influence on MACE duration and efficacy of PCI were equal Bernat I. STEMI-RADIAL (2012) 707 STEMI pts randomized, femoral (n=359) vs. radial (n=348) acces radial: lower rate of major bleeding and access-site complications, increase in net clinical benefit Larsen and all (2011) pPCI in AMI retrospective 135 pts LRA vs RRA no difference in success rate, procedure duration, room-to-balloon time and safety profile
- 11. Genereux et all (2011) HORIZONS-AMI In pts with STEMI undergoing pPCI TR approach was associated with reduced major bleeding and improved event-free survival Jang et all (2012) meta-analysis TR PCI reduces periprocedural bleeding and improve clinical outcomes in pts with STEMI Shiahbasi and all (2011) TALENT 1500 pts LRA vs RRA experienced radial operator no difference Diletti and all (2013) 1032 pts 420 RRA, 612 LRA no differences in MACCE and success rate ESC Guidelines STEMI (2012) experienced radial operator radial access should be prefered over femoral
- 12. in pts with STEMI undergoing primary PCI to establish whether the type of access had an influence on the: • • • procedure success, procedure and fluoroscopy time and bleeding complication counted as periprocedural blood loss
- 14. Retrospective analysis 767 patients (pts) with STEMI, treated in our Center with primary PCI from 01.01.2011. to 01.05.2013. Data from registry and medical records 334 pts (43,5%) directly admitted and 433 pts (56,5%) transported from other hospitals
- 15. STEMI pts - 767 Femoral 244 (31,8%) Radial 523 (68,2%) Left radial 413 (78,9%) Right radial 110 (21,1%)
- 16. Total Femoral Radial Left Right Gender (M ) 71,4 % 68,7% 72,7% 73,9% 68,4% Age (yrs) 62,7±12,1 64,1±12,1 62,1±11,9 62,3±12,1 61,3±11,8 Hight (cm) 171,5±14,2 171,6±8,6 171,4±15,7 172,1±13,3 171,1±8,2 Weight (kg) 83,7±15,7 83,2±8,6 83,8±15,7 83,6±14,4 84,7±19,3 Culprit vessel (LAD/Acx/LM) 61,2% 61,9% 60,8% 60,8% 60% Culprit vessel (ACD ) 38,8% 37,6% 39,2% 39,1% 40% No. of STENTs implanted 1,17±0,63 1,16±0,65 1,18±0,62 1,18±0,61 1,18±0,68
- 17. Efficiency: procedure success, “door to balloon” time Operator safety: total procedure time, fluoroscopy time and radiation dose Patient safety: periprocedural blood loss
- 20. p=0,358 80.5 70.5 60.5 50.5 40.5 30.5 20.5 10.5 0.5 72.0 Radial p=0,996 73.3 71.9 80.5 70.5 60.5 50.5 40.5 30.5 20.5 10.5 0.5 Femoral Total procedure time (min) Left R 72.7 Right R Total procedure time (min) Radial 72±19 Left R 71,9±18,4 Femoral 73,3±21 Right R 72,7±21,3
- 21. p=0,476 50.5 40.7 41.7 p=0,863 50.5 40.5 30.5 20.5 20.5 10.5 10.5 0.5 41.8 40.5 30.5 40.4 0.5 Radial Femoral Door to balloon time (min) Left R Right R Door to balloon time (min) Radial 40,7±15,4 Left R 40,4±14,1 Femoral 41,7±16,1 Right R 41,8±19,2
- 22. p=0,236 12.1 p=0,128 11.6 12.5 12.8 14.5 12.5 10.5 8.5 6.5 4.5 2.5 0.5 10.5 8.5 6.5 4.5 2.5 0.5 Radial Femoral 11.1 Left R Right R Fluoroscopy time (min) Fluoroscopy time (min) Radial 12,1±7,4 Left R 11,1±6,9 Femoral 11,6±9,3 Right R 12,8±8,2
- 23. p=0,218 p=0,869 13313 12853 14001 12001 10001 8001 6001 4001 2001 1 11048 Radial Femoral Radiation dose (cGy/cm2) 11696 14001 12001 10001 8001 6001 4001 2001 1 Left R Right R Radiation dose (cGy/cm2) Radial 12853±2521 Left R 13313±2436 Femoral 11048±2876 Right R 11696±2871
- 24. p=0,254 9.9 p=0,673 10.4 9.9 10.5 10.5 8.5 8.5 6.5 6.5 4.5 4.5 2.5 2.5 0.5 9.8 0.5 Radial Femoral Difference in Hb (g/L) Left R Right R Difference in Hb (g/L) Radial 9,9±8,4 Left R 9,9±8,1 Femoral 10,4±8,8 Right R 9,8±8,9
- 26. "Negative randomization": more demanding and challenging pts were chosen for femoral approach Operator choice: preferences of individual operator Crossover rate: worsens the femoral statistics
- 28. (% of pPCI with radial approach) 100% 90% 80% 70% 60% 2011 2012 2013 50% 40% 30% 20% 10% 0% Z.B. H.P. I.D.G. M.T. Š.M. V.R. T.K. V.N.H.
- 29. R-F 8.0% First crossover choice: contralateral radial and/or ulnar 6.0% 4.0% 2.0% 0.0% 2011 2012 2013 R-F 2011 6.3% 2012 4.2% 2013 3.7%
- 31. In pts with STEMI undergoing primary PCI in radial dedicated Center there is no difference in effectiveness, safety and blood loss between radial and femoral approach. Also there is no significant difference in either left or right radial access type.
- 32. LEFT RIGHT You can do it radial! OR Thank you Both
- 33. Gabrić ID, Pintarić H, Babić Z, Trbušić M, Krčmar T, Nikolić-Heitzler V, Manola Š, Radeljić V, Zeljković I University Hospital Center Sestre milosrdnice Zagreb, Croatia