Operator and institutional experience reduces room-to-balloon times for transradial primary percutaneous coronary intervention.
BACKGROUND
Transradial (TR) access for primary percutaneous coronary intervention (PCI) is becoming accepted as the preferred approach but has not gained widespread adoption due to technical challenges that may limit procedural success and delay time to revascularization, particularly among patients treated by inexperienced operators. We report our experience over the first 2 years of our TR primary PCI program and determined the impact of TR access on clinical and procedural outcomes.


METHODS
Clinical characteristics and procedural outcomes were collected prospectively from 488 patients presenting with ST-segment elevation myocardial infarction and compared according to whether patients underwent primary PCI via the TR or transfemoral (TF) approach.


RESULTS
Hospital mortality was very low in both groups (1.1% [TR] vs 2.6% [TF]; P=.23). Access-site intended procedural success for primary PCI was equivalent (98.4% for TR vs 98.6% for TF; P=.85). Catheterization room-to-balloon (RTB) times were significantly lower among patients undergoing TR primary PCI as compared with those in the TF group (20:33 ± 06:41 [TR] vs 25:11 ± 08:22 [TF]; P<.001). TR patients treated by operators who had performed >50 TR PCIs had lower RTB times (20:03 ± 06:12 vs 24:26 ± 10:01; P<.06) and lower doses of radiation exposure (1812 ± 1007 mGy vs 2827 ± 954 mGy; P<.01) than patients treated by less experienced operators. Dual-purpose guide catheter usage was also associated with lower RTB times (18:38 ± 5:42 vs 25:15 ± 8:20; P<.001) and radiation exposure (1824 ± 6205 mGy vs 2407 ± 1389 mGy; P<.01).


CONCLUSIONS
TR primary PCI may be performed rapidly and successfully despite only modest operator and institutional experience.
Cardiovascular Division, University of Massachusetts Medical School, S3-853, 55 Lake Avenue North, Worcester, MA 01655 USA. Barringk@ummhc.org.
Kurt G
KG
Barringhaus
Mohammed
M
Akhter
Jeffrey J
JJ
Rade
Craig
C
Smith
Daniel Z
DZ
Fisher
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D002300:Cardiac Care Facilities / Q000592:standards*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005263:Femoral Artery; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000592:standards*; D011446:Prospective Studies; D017534:Radial Artery; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome