Association of Adoption of Transradial Access for Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction with Door-to-Balloon Time -…

OBJECTIVES:

We aimed to study adoption of transradial primary percutaneous coronary intervention (TR-PPCI) for ST elevationmyocardial infarction(STEMI) (radial first approach) and its association with door-to-balloon time (D2BT).

TR-PPCI for STEMI is underutilized in the United States due to concerns about prolonging D2BT. Whether operators and hospitals adopting a radial first approach in STEMI incur prolonged D2BT is unknown.

In 1,272 consecutive cases of STEMI with PPCI at our hospital from January 1, 2011, to December 31, 2016, we studied TR-PPCI adoption and its association with D2BT including a propensity matched analysis of similar risk TR-PPCI and trans-femoral primary PCI (TF-PPCI) patients.

With major increases in hospital-level TR-PPCI (hospital TR-PPCI rate: 2.6% in 2011 to 79.4% in 2016, p-trend<.001) and operator-level TR-PPCI (mean operator TR-PPCI rate: 2.9% in 2011 to 81.1% in 2016, p-trend = .005), median hospital level D2BT decreased from 102min [81, 142] in 2011 to 84min [60, 105] in 2016 (p-trend<.001). TF crossover (10.3%; n = 57) was not associated with unadjusted D2BT (TR-PPCI success 91min [72, 112] vs. TF crossover 99min [70, 115], p = .432) or D2BT adjusted for study year and presenting location (7.2% longer D2BT with TF crossover, 95% CI: -4.0% to +18.5%, p = .208). Among 273 propensity-matched pairs, unadjusted D2BT (TR-PPCI 98 [78, 117] min vs. TF-PPCI 101 [76, 132] min, p = .304), and D2BT adjusted for study year and presenting location (5.0% shorter D2BT with TR-PPCI, 95% CI: -12.4% to +2.4%, p = .188) were similar.

TR-PPCI can be successfully implemented without compromising D2BT performance.

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Association of Adoption of Transradial Access for Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction with Door-to-Balloon Time -...