Sajjad Hussain, Azhar Mahmood Kayani, Rubab Munir.
Trans-radial Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction.
J Coll Physicians Surg Pak Jan ;24(2):78-81.

Objective: To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of ≤ 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 ≤ 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT ≤ 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.

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