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).

Study Design: Case series.

Place And Duration Of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012.

Methodology: 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.

Conclusion: 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.