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?

Major Bleeding and Outcomes 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

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

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

Primary PCI: D2B 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

Recommendation for Avoiding Transradial Primary PCI Known radial artery anatomy that prevents quick access of diagnostic and PCI catheters Patients with hemodynamic instability Fail to obtain radial access in 3 min or >3 attempts.

Commonly Used Guide Catheters in Transradial PCI Left coronary artery JCL 3.5 my 1st choice learn to use it like AL XB LAD 3.5 AL2 Right coronary artery JR4 AL0.75 SVG 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