Transradial Intervention as Access of Choice in STEMI

David X. Zhao, M. D. I have no relevant financial relationships pertinent to this

Why Transradial First? Eikelboom et al Circulation 2006; 114: 774

STEMI RADIAL 30 -Day Major and Net Adverse Event Bernat et al JACC 2014;

Major Bleeding: Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Radial Access Transforms Bleeding Complications (n=12, 745) Radial vs Femoral Bleeding Rates Kiblboeck et

All Cause Mortality: Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Primary PCI: D 2 B and Other Outcomes Radial vs Femoral Arzamendi et al.

Overall Procedure Time Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Learning Curve: Primary PCI is Not the Time to Learn Kasasbeh & Zhao JIC

Advantage of Transradial Primary PCI • • Reduce major bleeding complication Reduce vascular complication

Recommendation for Starting Transradial Primary PCI • Operators with extensive experience in transradial PCI

Commonly Used Guide Catheters in Transradial PCI • Left coronary artery – JCL 3.

Conclusions • Transradial primary PCI reduces mortality and morbidity as compared to transfemoral approach

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Transradial Intervention as Access of Choice in STEMI David Zhao, MD, FACC, FSCAI Henry S. Miller Jr. Professor in Cardiovascular Medicine Professor of Medicine, Cardiothoracic and Vascular Surgery Chief, Section on Cardiovascular Medicine Executive Director, Heart and Vascular Center Wake Forest School of Medicine Winston Salem, NC

David X. Zhao, M. D. I have no relevant financial relationships pertinent to this presentation

Why Transradial First? Eikelboom et al Circulation 2006; 114: 774

STEMI RADIAL 30 -Day Major and Net Adverse Event Bernat et al JACC 2014; 63: 964

Major Bleeding: Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Radial Access Transforms Bleeding Complications (n=12, 745) Radial vs Femoral Bleeding Rates Kiblboeck et al, Linz Austria, TCT 358; 2016

All Cause Mortality: Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Primary PCI: D 2 B and Other Outcomes Radial vs Femoral Arzamendi et al. Am J Cardiol 2010

Overall Procedure Time Radial vs Femoral Karrowni et al. JAC Intv 2013; 6: 814

Learning Curve: Primary PCI is Not the Time to Learn Kasasbeh & Zhao JIC 2012; 24599 -604

Advantage of Transradial Primary PCI • • Reduce major bleeding complication Reduce vascular complication Lower mortality with primary PCI Facilitate aggressive anti-thrombotic therapies Improve patient comfort and patient satisfaction Earlier ambulation Reduce length of hospitalization and cost

Recommendation for Starting Transradial Primary PCI • Operators with extensive experience in transradial PCI (>75 -100 cases) with all lesion subsets and with commitment to “radial first” approach • Cath lab staff are familiar with transradial cath and PCI • Consider left radial in patients with LIMA graft • Routinely prep femoral access sites in the event of failed radial access or hemodynamic support

Commonly Used Guide Catheters in Transradial PCI • Left coronary artery – JCL 3. 5 Ø my 1 st choice Ø learn to use it like AL – XB LAD 3. 5 – AL 2 • Right coronary artery – JR 4 – AL 0. 75 • SVG – AL 0. 75 – MP

Conclusions • Transradial primary PCI reduces mortality and morbidity as compared to transfemoral approach • Outcomes are predicated on operator and institutional experience and volume • A “radial first” strategy should be a standard care for primary PCI