title: Does reducing ischemia time justify to catheterize firstly the culprit artery in every primary PCI?
abstract: No consensus exists about which coronary artery should be firstly catheterized in primary PCIs. Initial catheterization of the "culprit artery" could reduce reperfusion time. However, complete knowledge of coronary anatomy could modify revascularization strategy. The objective of the study was to analyze this issue in ST-elevation myocardial infarction patients undergoing primary PCI. PCIs were performed in 384 consecutive patients. Choice of ipsilateral approach (IA): starting with a guiding catheter for the angiography and PCI of the "culprit artery", or contralateral approach (CA): starting with a diagnostic catheter for the "non-culprit artery" and completing the angiography and PCI of the culprit with a guiding catheter was left to the operator. Differences between two approaches regarding reperfusion time, acute events or revascularization strategies were analyzed. There were no differences between two approaches regarding reperfusion time or clinical events. When the left coronary artery was responsible, IA was more frequent (76.4 vs 22.6 %), but when it was the right coronary artery, CA was preferred (20 vs 80 %); p < 0.0001. With CA, bare metal stents (BMS) were more used than drug eluting (DES) (60.8 vs 39.2 %) inversely than with IA (BMS 41.3 vs DES 59.7 %; p < 0.0001). With CA there were more patients with left main or multivessel disease in which revascularization was completed with non-urgent surgery (4.13 vs 2.4 %, p < 0.0001). Initial CA does not involve higher reperfusion time. Furthermore, overall knowledge of coronary anatomy offers more options in revascularization strategy and may imply a change in management. Despite the need to individualize each case, contralateral approach may be the first option with the exception of unstable patients.
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain. alfonsojuradoroman@gmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Jurado-Román
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: García-Tejada
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernández-Hernández
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Granda-Nistal
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Rubio-Alonso
authors.affiliation: Cardiology Department, Hospital Infanta Leonor, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Agudo-Quílez
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Velázquez-Martín
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Albarrán-González-Trevilla
authors.affiliation: Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Tascón-Pérez
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D062906:Cardiac Catheters; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D054855:Drug-Eluting Stents; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D013030:Spain; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Approach; Primary percutaneous coronary intervention; Radial; ST-elevation myocardial infarction