1. 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

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

3. Why Transradial?

4. Major Bleeding and Outcomes
Eikelboom et al Circulation 2006;114:774

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

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

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

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

9. Primary PCI: D2B and Other Outcomes Radial vs Femoral
Arzamendi et al. Am J Cardiol 2010

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

11. Learning Curve: Primary PCI is Not the Time to Learn
Kasasbeh & Zhao JIC 2012;

12. 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

13. Recommendation for Starting Transradial Primary PCI
Operators with extensive experience in transradial PCI (> 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

14. 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.

15. 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

16. 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