1. 2015-10-251 TRI vs TFI in STEMI Shenyang Northern Hospital Wang Shouli Han Yalin

2. At the beginning, TRI tended to be avoided in AMI patients----unexpected longer time for arterial cannulation Many studies have now demonstrated the safety, feasibility and good outcomes of primary PCI performed with TRI, and with a drastic reduction in vascular complications and length of in-hospital stays Backgrounds

3. According to guidelines, patients with TFI undergo aggressive anticoagulation, which leads eventually to an increased incidence of bleeding (up to 7%) However, the combination of GP Ⅱ b/ Ⅲ a inhibitors and catheterization with TRI is virtually avoid from serious bleeding Backgrounds

4. Why are we reluctant to do TRI for AMI? puncture more difficult ! longer time to ballooning ! difficult to put IABP balloon ! not convenience for pacing !

5. Advantages of TRI for AMI Less bleeding complications Quick access Easy to compress Saving the femoral arteries for the hemodynamic support, if necessary Quick ambulation Shorter hospital stay

6. RADIal versus femoral approach for percutaneous coronary interventions in patients with Acute Myocardial Infarction (RADIAMI):A prospective, randomized, single-center clinical trial Piotr Chodór, et al. Cardiol J 2009; 16, 4: 332–340

7. Flow chart of patients’ in-hospital course Cardiol J 2009; 16, 4: 332–340

8. Time intervals during coronary angiography and PCI

9. In-hospital course

10. The TRI in AMI has the same efficacy as TFI No differences in total procedure duration, X- ray exposition or volume of contrast A longer time from the patient’s admission to the individual stages of the PCI procedure in TRI was mostly due to the longer times of the initial stages of the procedure The use of TRI reduces the time to ambulation and allows rehabilitation to begin sooner In both groups, bleeding complications occurred rarely Conclusions:

11. Hon-Kan Yip,et al. Circ J 2009; 73: 2050 – 2055 Safety and Efficacy of Transradial vs Transfemoral Arterial Primary Coronary Angioplasty for Acute Myocardial Infarction Single-Center Experience

12. Hon-Kan Yip,et al. Circ J 2009; 73: 2050 – 2055 TRA TFA ≤Killip 3

13. TRA TFA

14. TRA

15. Initial selection of TRA is not inferior to initial selection of TFA for AMI patients undergoing primary PCI The incidence of combined vascular and bleeding complications was lower with the TRA than with the TFA approach Conclusions:

16. TRITFIP value Successful catheterization （ % ） 494/512(96.5%)511/512(99.8%) ＜ 0.0001 Median procedural duration （ min ） 37.0(19.6-49.1)40.2(24.3-50.8)=0.046 median dose area product(Gycm2) 38.2(20.4-48.5)41.9(22.6-52.2)=0.034 Vascular access site complications % 0.58%3.71%= 0.0008 Martin Brueck, et al. JACC: Cardiovascular Interventions, 2009,11(2):1047-1054 A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

17. Transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction: Systematic overview and meta-analysis Andra´s Vorobcsuk et al. Am Heart J 2009;158:814-21.

18. 3324 patients

23. Results 12 studies involving 3324 patients were identified. TRI reduced major bleeding compared to TFI(P=0.0001),and significant reductions were found in the composite of death, MI,or stroke (P=0.01).Mortality reduction showed a significant toward benefit in the case of TRI(2.04% vs 3.06%, OR 0.54 ｛ 95% CI 0.33-0.86 ｝,P=.01).The fluoroscopic time was longer, and access site crossover was more frequent for TRI(P=.001,P ＜.00001,respectively).

24. Conclusions TRI reduces the risk of periprocedural major bleeding and major adverse events in the STEMI setting Andra´s Vorobcsuk et al. Am Heart J 2009;158:814-21.

25. Our single center data

32. My personal experience The introduction of TRI reduces the vascular access site complication TRI is as feasible as TFI in those patients. We must read the patient’s history carefully before doing PCI ECG may help us to identify the target vessel in STEMI or NSTEMI patient before PCI I suggest TFI if the ECG indicate the target vessel is RCA or LCX

33. 谢谢