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Impact of the Learning Curve and the Time of Day on the Procedure in STEMI Patients Undergoing Primary PCI with Left Radial Approach

PURPOSE: In the last few years, our center has become dedicated to the radial approach with nearly 85% of PCI performed with either left or right radial access route. In time radial approach has become the first choice even in patients with STEMI. The aim of the study was to establish whether the type of access had an influence on the procedure success, procedure and fluoroscopy time, and bleeding complication counted as periprocedural blood loss in STEMI patients undergoing primary PCI. METHODS: In this retrospective analysis, we included 767 patients with STEMI treated in our center with primary PCI from January 1, 2011 to January 5, 2013. Radial approach was used in 523 patients (68.2%) (TR group), divided according to the site of access in either “left” (413 patients ; 78.9%) or “right” (110 patients ; 21.1%) subgroups. Femoral route was used in 244 patients (TF group). RESULTS: There was no significant difference in procedure success, door-to-balloon time, total procedure time, fluoroscopy time and radiation dose between TR and TF groups. In sub-analysis of TR group, we did not find that left or right side access had any significant influence on any of the analyzed parameters. Also, there were no differences in periprocedural blood loss between TR and TF procedural access route (drop of hemoglobin, TR = 10±10 vs TF = 11±11 g/L, p=0.254), as well as in either left or right TR approach (drop of hemoglobin, left = 10±10 vs right = 10±12 g/L, p=0.254). CONCLUSION: In patients with STEMI undergoing primary PCI in a radial dedicated center, there is no difference in effectiveness, safety, and blood loss between radial and femoral approach. Also there is no significant difference in either left or right radial access type

STEMI, PCI, radial approach, learning curve

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