ABSTRACT
Background: The transfemoral approach [TFA] has been until presently the main-stay for arterial access PCI in the setting of acute STEMI, while the transradial approach [TRA] is gaining ground in elective as well as primary procedures
Objectives: to assess the impact of transradial versus transfemoral approach for PCI on the outcome of patients presenting with acute coronary syndrome
Patients and Methods: prospective study was conducted on 100 patients presenting to Ain Shams University Hospitals Coronary Care Unit [CCU] with recent onset acute coronary syndrome [whether unstable angina [UA]/non-ST-segment-elevation MI [NSTEMI] or ST-segment-elevation MI [STEMI]] undergoing revascularization via percutaneous coronary intervention [PCI]. Patients were randomized into 2 equal groups, for the first group PCI was performed via TFA while for the second group via TRA
Results: Our study found that, with TRA we get less bleeding, less local vascular complications [8 [16%] vs 2 [4%], p=0.045] and less amount of dye used [169.60 +/- 21.28 versus 187.00 +/- 37.65 ml, p=0.006] without significant increase in fluoroscopy time [10.86 +/-4.88 versus 9.76 +/-4.74 mins, p=0.256] or radiation exposure. Although there was no significant difference in mortality and morbidity, TRA offers the patient a more simple procedure with less hospital stay [3.4 +/-0.948 versus 3.86 +/-0.808 days, p<0.01]
Conclusion: Radial artery access is a safe and effective approach for management of ACS. If performed by experienced operators, TRA should be the standard access in managing ACS specifically in STEMI
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/methods , Radial Artery , Femoral Artery , Prospective StudiesABSTRACT
Background: the potential benefits of routine early intervention after thrombolysis include prevention of re-infarction, recurrent ischemia, and reduction of the infarct size and mortality
Aim of the work: the purpose of this study is to compare routine early coronary angioplasty in patients with acute anterior STEMI after successful thrombolysis versus ischaemia-guided coronary angioplastyas regards the occurrence of MACCE
Study design: a total number of 100 patients with acute anterior STEMI received thrombolytic therapy and then were randomly assigned to either routine invasive strategy or ischemia based strategy based on risk stratification by stress myocardial perfusion scan done within 30 days of the onset of AMI with subsequent CA after demonstration of residual myocardial ischemia and or good viability
Results: the cumulative incidence of MACCE including recurrent ischemia, stroke, MI, HF or mortality was significantly lower in theroutine early invasive strategy
Conclusion: STEMI patients who cannot undergo timely primary PCI should receive prompt fibrinolysis followed by early routine invasive strategy