Comparison of Vascular Access in STEMI

Study Overview
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Brief Summary
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Distal radial access (DRA) has recently introduced and previous studies have demonstrated that it is feasible option, showing several advantages including less bleeding and access-site complications over proximal radial access (PRA). Previous study reported the feasibility of DRA as an alternative option for primary percutaneous coronary intervention (PCI) in STEMI patients without major complication. However, comparison study of each vascular access for primary PCI have not been conducted until now. Here, The investigators aim to compare the DRA, PRA and femoral access (FA), in terms of feasibility and safety, in patients with STEMI. This is a retrospective study with patients who underwent primary PCI for STEMI between March 2020 to May 2021. The primary outcome of this study is the access-site complication including major bleeding requiring transfusion or surgery, hematoma and arterial occlusion.

Detailed Description
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Recently, DRA has gained the interest of interventional cardiologists and previous studies have demonstrated several advantages including patient and operator comfort, shorter hemostasis duration, less bleeding, and access-site complications over PRA. More recently, randomized trial demonstrated that DRA prevents radial artery occlusion after the procedure compared with PRA. From this perspective, DRA could be considered an alternative access route for primary PCI in selected STEMI patients using potent P2Y12 inhibitors such as ticagrelor or prasugrel, or glycoprotein IIb/IIIa inhibitors.

Official Title
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Comparison of Distal Radial, Proximal Radial and Femoral Access in ST-Segment Elevation Myocardial Infarction

Conditions
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ST Elevation Myocardial Infarction

Intervention / Treatment
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* Procedure: Distal radial access


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between March 2020 to May 2021, patients who underwent primary PCI for STEMI at the Yongin Severance Hospital Exclusion Criteria: Refractory cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Distal radial access|Vascular access for primary PCI in patients with STEMI|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| access-site complication | puncture site related complication | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The success rate of the puncture | The success rate (%) of vascular puncture | Through procedure | 
| The success rate of the primary PCI | Success rate (%) = Successful primary PCI / All PCI procedures | Through procedure | 
| The percentage of puncture time in Door-to-wiring time (%) | Puncture time = time interval from local anesthesia induction to successful sheath cannulation. Door-to-wiring time = time elapsed from arrival of patient at the emergency department to guide wire passage through the lesion. | Through procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Distal radial access, Snuffbox approach, ST Elevation Myocardial Infarction