title: Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary intervention for ST-elevation myocardial infarction.
abstract: BACKGROUND
  Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients.
  
  
  METHODS
  A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated.
  
  
  RESULTS
  There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA.
  
  
  CONCLUSIONS
  Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Hongyu
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Dezhao
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Zhixu
authors.initials: Z
authors.lastname: Tan
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Buxing
authors.initials: B
authors.lastname: Chen
mesh_terms: D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D061646:Operative Time; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery; D011829:Radiation Dosage
keywords: ST-segment elevation myocardial infarction; primary percutaneous coronary intervention; transradial approach