Transradial access does not delay door-to-balloon times in STEMI PCI
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The increasing use of transradial access for PCI over time did not compromise door-to-balloon times in patients with STEMI requiring PCI, according to new findings.
The researchers analyzed 1,272 consecutive cases of primary PCI for STEMI (43.3% using initial transradial access) at Cleveland Clinic between 2011 and 2016 to determine any association between adoption of transradial PCI and door-to-balloon times.
“There is a lot of clinical evidence showing the superiority of radial-artery access in STEMI, but the United States’ adoption of it has been quite low overall,” Umesh N. Khot, MD, vice chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine and a staff cardiologist in the Section of Clinical Cardiology in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, told Healio. “One of the main reasons is there has been some concern that it may lead to delays in door-to-balloon time. The question is, what happens when entire cath lab decides to adopt radial-artery access, and what impact does it have on door-to-balloon times?”
Use of transradial PCI rose dramatically during the study period. According to the researchers, the hospital-wide rate was 2.6% in 2011 and 79.4% in 2016 (P for trend < .001), whereas the mean operator rate was 2.9% in 2011 and 81.1% in 2016 (P for trend = .005).
Door-to-balloon times
Median hospital-level door-to-balloon time dropped from 102 minutes (interquartile range [IQR], 81-142) in 2011 to 84 minutes (IQR, 60-105) in 2016, Khot and colleagues found.
Among patients in whom transradial PCI was initially attempted, the rate of crossover to transfemoral PCI was 10.3%, but this was not associated with door-to-balloon times, both unadjusted (successful transradial, 91 minutes [IQR, 72-112]; crossover, 99 minutes [IQR, 70-115]; P = .432) and adjusted for study year and presenting location (7.2% longer in crossover group; 95% CI, –4 to 18.5), according to the researchers.
Khot and colleagues also analyzed 273 propensity score-matched pairs from the transradial and transfemoral groups. In this analysis, door-to-balloon times did not differ between the groups, whether unadjusted (transradial, 98 minutes [IQR, 78-117]; transfemoral, 101 minutes [IQR, 76-132]; P = .304) or adjusted for study year and presenting location (5% shorter in transradial group; 95% CI, –12.4 to 2.4).
Transition feasible
“We had a dramatic increase in radial artery access from 2011 to 2016, yet no matter how we looked at the data, we did not really see any worsening of door-to-balloon times,” Khot told Healio. “In fact, overall door-to-balloon time improved by the end of the study. What that says is that an entire cath lab can transition from femoral access to radial access and not really see an impact on door-to-balloon times.”
In the future, one of the perceived barriers to adopting transradial access may disappear, Khot said, noting that “people can move forward with adopting radial-artery access, which has benefits in terms of bleeding reduction and signals in terms of improved mortality.” – by Erik Swain
For more information:
Umesh N. Khot, MD, can be reached at Cleveland Clinic Heart and Vascular Institute Center for Healthcare Delivery Innovation, Desk J2-4, 9500 Euclid Ave., Cleveland, OH 44195; email: khotu@ccf.org; Twitter: @umeshkhotmd.
Disclosures: Khot reports he has consulted for AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.
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