1. My Best Radial Case of the Past Year ... And what I learned from it
CRT 2017
February 20, 2017

2. Disclosures Consulting: Research Grants: Terumo Interventional Systems
Boston Scientific
Medtronic
Acist Medical
Research Grants:
Edwards LifeSciences
Abbott

3. Case Presentation 67 year old male No significant PMH
Called EMS with chest pain of 1 hour duration
Cardiac arrest essentially as EMS arrived
ACLS per protocol
Initial rhythm VF
Shocked with ROSC
Intubated in field
ECG with inferior ST-elevation
Field activated STEMI
Taken straight to Cath Lab on arrival
Hemodynamically stable, Killip Class 2
Modified Allen’s Normal – yes, we still check

4. STEMI - Prep

5. 6F Access – IL 3.5 Guide System connected from beginning
0.035” J-wire left in guide catheter
Pulled back a few inches for left coronary system
I still prefer contralateral first approach

6. 6F Access – IL 3.5 Guide Advance J-wire almost to guide tip for RCA
Will leave in place until 0.014” wire down
Convert passive support to active support

7. Standard STEMI Management

8. STEMI – Primary PCI

9. Inferior STEMI (field activated)
Times:
Symptoms to EMS – 60 minutes
EMS to Door – 32 minutes
Door to Cath Lab – 5 minutes
Cath lab to Access time – 9 minutes
Access to Device time – 12 minutes
Metrics:
Door to Device time – 24 minutes
EMS to Device time – 56 minutes

10. Post Cath Course Taken to CVICU upon case completion
Targeted Temperature Management
Post STEMI care
No residual defects
Discharged on hospital day # 5.
Seen in clinic for follow-up …

11. Why this case . . . Was this really my “best case”???
No.
Transradial STEMI is routine in our lab.
The RCA was straightforward.
It’s a good result, but nothing special
Was this my best ”learning experience”
In full disclosure:
I’ve been totally schooled over the past year.
I tend to remember and learn from negatives.

12. We can Learn from Positives as well
This is access, not religion.
Bleeding reduction is a good thing.
Coaxial guide engagement is what matters.
We are here to treat patients.
Excepts from past conferences.

13. RIFLE STEACS 30-day MACE rate p = 0.02 p = 1.00 p = 0.6 p = 0.73
Romagnoli et al. J Am Coll Cardiol 13

14. RIFLE STEACS 30-day NACE predictors OR CI 95% p value Female gender
1.5
( )
0.037
CKD
2.1
( )
0.001
Radial access
0.6
( )
0.012
Killip class
1.8
( )
LAD culprit
1.7
( )
0.006
TIMI 0 basal
1.4
( )
0.073
LVEF <50%
1.6
( )
0.025
TIMI 0-1 final
2.4
( )
0.024
p= 0.002
Romagnoli et al. J Am Coll Cardiol

15. NCDR CathPCI Registry Access Trends
STEMI (n=90,879)
Baklanov et al. J Am Coll Cardiol

16. NCDR CathPCI Registry STEMI 2007-2011 (n=90,879)
Baklanov et al. J Am Coll Cardiol

17. Conclusions We can learn from all experiences
Positive and negative
The work that we do really does translate back to the patient

18. Thank You