Transradial Primary Percutaneous Coronary Intervention is Associated with Low Rates of Clinical and Cardiovascular Events in Patients with Acute ST Elevation Myocardial Infarction

Öz

OBJECTIVE: The transradial (TR) approach has been increasingly employed as an alternative approach to the transfemoral (TF) approach in percutaneous coronary intervention (PCI). We aimed to investigate the impact of TR approach on clinical outcomes in 1st and 6th months compared with a TF approach in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI.METHODS: Three hundred fifteen patients who underwent primary PCI for STEMI were evaluated retrospectively. TR approach group consisted of 55 patients (19 females, mean age: 55±10 years), and TF approach group consisted of 74 patients (21 females, mean-age 53±9 years). Endpoints included the rates of major adverse cardiovascular events (MACE: death, recurrent MI, target lesion revascularization and stroke) and net adverse clinical events (NACE: MACE and bleeding) at the first and six-months.RESULTS: The two groups were similar in terms of baseline clinical characteristics. Arterial cannulation, door-to-balloon and total-procedure times, and access-site crossover rates were not significantly different between TR approach and TF approach groups (p=0.966, p=0.139, p=0.393, and p=0.197; respectively). While infarction localizations and the numbers of treated vessel were similar in both groups, the use of tirofiban was higher (p=0.025) and hospital stay was lower (p=0.017) in TR approach. The 30-day rate of MACE was lower in TR approach than that in TF approach, but not statistically significant (p=0.119). The 30-day rate of NACE was significantly lower in TF approach (p=0.006). At the 6th month, the TR approach had significantly lower rates of MACE (p=0.039) and NACE (p=0.002) as compared to TF approach. CONCLUSION: TR approach had similar procedural times and was associated with lower clinical and cardiovascular events in patients with STEMI undergoing primary PCI as compared to those of TF approach.

Anahtar Kelimeler

• Transradial approach, acute myocardial infarction; primary percutaneous coronary intervention; clinical outcomes

Akut ST Yükselmeli Miyokard İnfarktüslü Hastalarda Transradiyal Primer Perkütan Koroner Girişim Düşük Klinik ve Kardiyovasküler Olaylar ile İlişkilidir

Öz

AMAÇ: Son yıllarda perkütan koroner girişim (PKG)'e alternatif bir yaklaşım olarak transradiyal (TR) yöntem artan bir şekilde kullanılmaktadır. Biz bu çalışmada, primer PKG'ye alınan ST yükselmeli miyokard infarktüs (STYMİ)'lü hastalarda transfemoral (TF) yöntem ile kıyaslandığında TR yöntemin birinci ve altıncı aydaki klinik sonuçlar üzerindeki etkisini araştırmayı amaçladık.YÖNTEMLER: STYMİ için primer PKG'ye alınan 315 hasta geriye-dönük olarak değerlendirildi. Dışlama kriterleri belirlendikten sonra, TR yöntemi uygulanan grup 55 hasta (19 kadın, ortalama yaş 55±10 yıl), TF yöntemi uygulanan grup ise 74 hastadan (21 kadın, ortalama yaş 53±9 yıl) oluştu. Sonlanım noktası; birinci ve altıncı aylardaki majör istenmeyen kardiyak olay (MKO: ölüm, tekrarlayan Mİ, hedef lezyon revaskülarizasyonu ve inme) ve net istenmeyen klinik olay (NKO: MKO ve kanama) oranlarından oluştu. BULGULAR: Her iki grup bazal klinik özellikler bakımından benzerdi. Artere giriş, kapı-balon ve toplam işlem süreleri gruplar arasında önemli bir farklılık göstermedi (sırasıyla; p=0,966, p=0,139 ve p=0,393). Her iki grup benzer arter-giriş yeri değiştirme oranlarına sahipti (p=0,197). İnfarktüs yerleşimi ve tedavi edilen damar sayıları gruplar arasında benzer iken, TR yönteminde tirofiban kullanımı daha fazla (p=0,025) ve hastanede kalış süresi daha kısa (p=0,017) idi. Otuz günlük MKO oranı, TR yönteminde TF yöntemine göre daha düşük olmasına rağmen istatistiksel olarak önemli değildi (p=0,119). Otuz günlük NKO oranı TR yönteminde anlamlı olarak daha düşüktü (p=0,006). Altıncı ayda, TF yaklaşımı ile karşılaştırıldığında TR yaklaşımı daha düşük MKO (p=0,039) ve NKO (p=0,002) oranlarına sahipti. SONUÇ: Çalışmamızın bulguları primer PKG'ye alınan STYMİ hastalarında TF yaklaşımı ile karşılaştırıldığında TR yaklaşımının benzer işlemsel sürelere sahip olup, daha düşük klinik ve kardiyovasküler olaylar ile ilişkili olduğunu gösterdi.

Anahtar Kelimeler

• Transradiyal yaklaşım, akut miyokard infarktüsü; primer perkütan koroner girişim; klinik sonuçlar

Kaynakça

1. Moscucci M, Fox KA, Cannon CP, Klein W, López-Sendón J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24:1815-23.
2. Choussat R, Black A, Bossi I, Fajadet J, Marco J. Vascular complications and clinical outcomes after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs transfemoral arterial access. Eur Heart J 2000;21:662-7.
3. The PRISM-PLUS Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q wave myocardial infarction. N Engl J Med 1998;338:1488-97.
4. Campeau L. Percutaneous radial artery approach for coronary angioplasty. Catheter Cardiovasc Diagn 1989;16:3-7.
5. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Catheter Cardiovasc Diagn 1993;30:173-8.
6. Khan M, Qadir F, Hanif B, Villani A, Ahmedins B. To determine the safety and success of transradial coronary angiography and angioplasty. A local experience. J Pak Med Assoc 2010;60:809-13.
7. Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesing L, Burket MW, Basu A, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J 1999;138:430-6.
8. Oweida SW, Roubin GS, Smith RB, Salam AA. Post-catheterization vascular complications associated with percutaneous transluminal coronary angioplasty. J Vasc Surg 1990;12:310-5.

9. Bittl JA. Comparative safety profiles of hirulog and heparin in patients undergoing coronary angioplasty. Am Heart J 1995;130:658-65.
10. Nasser TK, Mohler ER, Wilensky RL, Hathaway DR. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol 1995;18:609-10.
11. Yiğit F, Sezgin AT, Erol T, Demircan S, Tekin G, Katircibasi T, et al. An experience on radial versus femoral approach for diagnostic coronary angiography in Turkey. Anadolu Kardiyol Derg 2006;6:229-34.
12. Kedev S. Transradial and transulnar access for percutaneous coronary interventions. Turk Kardiyol Dern Ars 2011;39:332-40.
13. Yurtdaş M, Kaya Y, Gönüllü E. Transradial approach in the diagnosis and treatment of coronary artery disease: A two-center experience. Turk J Med Sci (2013), http://dx.doi.org/10.3906/sag-1212-93.
14. Maddury J, Kaushik M, Madhavapeddi A, Babu S, Kumar N, Varma JLN, et al. Feasibility and safety of elective transradial coronary intervention in Asian females. J Invasive Cardiol 2011;23:95-9.
15. Saito S, Tanaka S, Hiroe Y, Miyashita Y, Takahashi S, Tanaka K, et al. Comparative study on transradial approach vs transfemoral approach in primary stent implantation for patients with acute myocardial infarction: Results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial. Cathet Cardiovasc Intervent 2003;59:26-33.
16. Jen HL, Yin WH, Chen KC, Freng AN, Ma SP, Cheng CF, et al. Transradial approach in myocardial infarction. Acta Cardiol 2011;66:239-45.
17. Chodor P, Krupa H, Kurek T, Sokal A, Swierad M, Was T, et al. RADIal versus femoral approach for percutaneous coronary interventions in patients with Acute Myocardial Infarction (RADIAMI): A prospective, randomized, single-center clinical trial. Cardiol J 2009;16:332-40.
18. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task force for the redefinition of myocardial infarction. Universal definition of myocardial infarction. Eur Heart J 2007;28:2525-38.
19. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the bleeding academic research consortium. Circulation 2011;123:2736-47.
20. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: A case for standardized definitions. Circulation 2007;115:2344-51.
21. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93:879-88.
22. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB, Peterson KL et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988;78:486-502.
23. Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007;297:159-68.
24. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, Armstrong PW, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004;292:1555-62.
25. Sciahbasi A, Pristipino C, Ambrosio G, Sperduti I, Scabbia EV, Greco C, et al. Arterial access-site-related outcomes of patients undergoing invasive coronary procedures for acute coronary syndromes (from the ComPaRison of Early Invasive and Conservative Treatment in Patients With Non-ST- ElevatiOn Acute Coronary Syndromes (PRESTO-ACS) Vascular Substudy). Am J Cardiol 2009;103:796-800.
26. Hermanides RS, Ottervanger JP, Dambrink JH, de Boer MJ, Hoorntje JC, Gosselink AT, et al. Incidence, predictors and prognostic importance of bleeding after primary PCI for ST-elevation myocardial infarction. EuroIntervention 2010;6:106-11.
27. Géneréux P, Mehran R, Palmerini T, Caixeta A, Kirtane AJ, Lansky AJ, et al. Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial. Eurointervention 2011;7:905-16.
28. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial versus femoral randomized investigation in st- segment elevation acute coronary syndrome: The RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) Study. J Am Coll Cardiol 2012;60:2481-9.
29. ten Berg JM, van‘t Hof AWJ, Dill T, Heestermans T, van Werkum JW, Mosterd A, et al. Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short and long-term clinical outcome. J Am Coll Cardiol 2010;55:2446-55.
30. Allen C, Glasziou P, Del Mar C. Bed rest: A potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229-33.
31. Ball WT, Sharieff W, Jolly SS, Hong T, Kutryk MJB, Graham JJ, et al. Characterization of operator learning curve for transradial coronary interventions. Clinical Perspective. Circ Cardiovasc Interv 2011;4:336-41.
32. Dehghani P, Mohammad A, Bajaj R, Hong T, Suen CM, Sharieff W, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. J Am Coll Cardiol Intv 2009;2:1057-64.
33. Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, et al. National cardiovascular data registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009;338:1807-14.
34. Kajiya T, Agahari F, Wai KL, Tai BC, Lee CH, Chan KH, et al. A single- center experience of transitioning from a routine transfemoral to a transradial intervention approach in ST-elevation myocardial infarction: Impact on door-to-balloon time and clinical outcomes. J Cardiol (2013), http://dx.doi. org/10.1016/j.jjcc.2013.02.008.
35. Pancholy S, Patel T, Sanghvi K, Thomas M, Patel T. Comparison of door- to-balloon times for primary PCI using transradial versus transfemoral approach. Catheter Cardiovasc Interv 2010;75:991-5.