title: Feasibility limits of transradial primary percutaneous coronary intervention in acute myocardial infarction in the real life (TRAP-AMI).
abstract: BACKGROUND
  There is growing evidence that transradial (TRI) as compared to transfemoral (TFI) percutaneous coronary intervention (PCI) is associated with improved clinical outcome driven by less hemorrhagic complications, in particular in STEMI patients receiving aggressive antithrombotic treatment. Feasibility rate of TRI in STEMI patients has not yet been evaluated.
  
  
  RESULTS
  Four-hundred seventy-five consecutive STEMI patients (<12h) without cardiogenic shock were prospectively screened for this all-comer single-centre registry between January 2008 and August 2010. Nine patients were excluded for a priori ineligibility for TRI (forearm shunt for dialysis, prior TRI failure). In the 466 patients enrolled, the operator's opinion about ease of radial puncture was assessed in 4 categories, based on radial pulse quality. Operators were advised not to attempt TRI if ease of puncture was judged "probably difficult/impossible". In case of puncture failure the operator switched immediately to TFI. The mean age of patients was 61 ± 14 (range 27-94) years. Seventy-three percent were men, 17% had diabetes. Nine percent had previous PCI. Glycoprotein inhibitors were used in 70%, and thrombectomy was performed in 70% of patients. PCI was performed using 6F and 5F guiding catheters. Procedural success rate was 98.2% (TIMI flow ≥ 2). In 4.1% (n=19) of patients the operator judged ease of radial puncture "probably difficult/impossible" and no TRI attempt was performed (primary TFI). In the 447 patients with TRI attempt, TRI failure requiring switch to TFI (secondary TFI) was necessary in 22 patients (4.7% of total) following radial puncture failure (n=15), dissection of the radial artery (n=1), prohibitive tortuosities or stenosis of the upper limb axis (n=2), or non-selective position or lack of stability of the guiding catheter (n=2). After the start of the angioplasty procedure, switch from TR to TF was not necessary in any patient. In total, the overall feasibility rate of TRI was 91.2%. Independent predictors of final TFI were age ≥ 80 years (adjusted OR: 2.37; 95% CI:1.05-5.34, p=0.037), body weight<60 kg (adjusted OR: 2.84; 95% CI:1.22-6.59, p=0.015); and previous PCI (adjusted OR: 3.42; 95% CI:1.40-8.37, p=0.007); female gender was borderline significant (adjusted OR:2.10; 95% CI:0.97-4.54, p=0.059).
  
  
  CONCLUSIONS
  In STEMI patients without cardiogenic shock and without a priori indication for TFI, PCI can be performed via the radial artery in more than 90% of cases with high procedural success rate. Operator's judgement of eligibility for TRI based on radial pulse quality is predictive of successful TRI in 95% of cases. TR failure is significantly more common in the elderly and in patients with low body weight.
authors.affiliation: Department of Cardiology, Henri Mondor University Hospital, Université Paris Est, Assistance Publique-Hôpitaux de Paris, Créteil F-94010, France; Department of Physiology, Henri Mondor University Hospital, Université Paris Est, Assistance Publique-Hôpitaux de Paris, Créteil F-94010, France; INSERM Unité 955, Créteil F-94010, France. Electronic address: barnabas.gellen@hmn.aphp.fr.
authors.forename: Barnabas
authors.initials: B
authors.lastname: Gellen
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Lesault
authors.forename: Florence
authors.initials: F
authors.lastname: Canouï-Poitrine
authors.forename: Stéphane
authors.initials: S
authors.lastname: Champagne
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.forename: Dionyssis
authors.initials: D
authors.lastname: Pongas
authors.forename: Aurélie
authors.initials: A
authors.lastname: Le Thuaut
authors.forename: Tomislav
authors.initials: T
authors.lastname: Jakljevic
authors.forename: Sélim
authors.initials: S
authors.lastname: Boudiche
authors.forename: Marcos
authors.initials: M
authors.lastname: de la Vega
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Maalej
authors.forename: Aurélie
authors.initials: A
authors.lastname: Veugeois
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D006328:Cardiac Catheterization / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery / Q000601:surgery*; D012042:Registries