Trans-radial primary percutaneous coronary intervention in ST-elevation myocardial infarction.
OBJECTIVE
To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of ² 90 minutes in primary PCI percutaneous Coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI).


METHODS
Case series.


METHODS
Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012.


METHODS
Systems goal for door-to-balloon time (DBT - time elapsed between first medical contact and restoration of flow in the infarct related artery [IRA]) was set at < 90 minutes. Procedural success was defined as restoration of TIMI 3 flow in the IRA with less than 30% residual stenosis and discharge from hospital. Non-infarct related arteries were not treated. Bleeding episodes were defined by TIMI definitions.


RESULTS
For vascular access for PPCI in a total of 207 patients, TRA was 91.3% (n = 189), transfemoral approach (TFA) 6.3% (n = 13) and brachial 2.4% (n = 5). Males represented 90.3% of cases and 7% were females. Mean age was 55 ± 10.86 years. Procedural success rate was 97.1%. Mean DBT was 54.1 minutes. DBT was less ² 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT ² 89.50 minutes was achieved in 90% of patients. The difference in DBT between the different access groups was not markedly different between the three groups. There were 6 (2.9%) in-hospital deaths and no major bleeds.


CONCLUSIONS
TRA for PPCI poses no hindrance to achieving a DBT of < 90 minutes in PPCI for STEMI. Furthermore, the in-hospital mortality rates are acceptable and within rational limits.
Department of Cardiology, Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi.
Sajjad
S
Hussain
Department of Cardiology, Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi.
Azhar Mahmood
AM
Kayani
Department of Cardiology, Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi.
Rubab
R
Munir
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D010154:Pakistan / Q000453:epidemiology; D017534:Radial Artery; D012042:Registries; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome