Distal Transradial Access for Primary PCI in STEMI Patients to Prevent RAO (RAPIDIII)

Distal TransRAdial Access for Primary Percutaneous Coronary Intervention in STEMI Patients to Prevent Acute Radial Artery Occlusion

Randomized-controlled trial to comparison of early radial artery occlusion via distal vs proximal radial artery among ST segment elevation myocardial infarction patients for primary percutaneous coronary intervention.

Proximal radial artery (PRA) is recommend as the default approach for patients undergoing percutaneous coronary intervention (PCI) according 2018 ESC guidelines. However, radial artery occlusion(RAO) remains the frequent complication, precluding the future use of radial artery as access point for repeat coronary recanalization or as a conduit for coronary artery bypass surgery. More than 50% of patients with ST segment elevation myocardial infarction(STEMI) presents multiple vascular lesions, of which 50% require reprocessing non-culprit vessels. Therefore, the patency of radial artery is crucial for STEMI patients. Distal radial artery(DRA), located in anatomical snuffbox or the dorsum of the hand, was introduced as a promising alternative. Three recent RCTs have shown significant reductions of RAO after DRA compared with PRA. Nevertheless, all of them excluded the patients presenting with STEMI. Therefore, we conduct a prospective, single-center, open-label randomized clinical trial to assess the superiority of preventing RAO at 24h via DRA when compared PRA among STEMI patients for primary PCI.

distal radial artey, radial artery occlusion, proximal radial artery, primary percutaneous coronary intervention

Successful puncture occurs when an introducer sheath can be properly placed through the punctured artery.

The puncture time was defined as the time interval between local anesthesia induction and successful sheath insertion.

FMC2D time was defined as the time interval between the patient's initial contact with the first physician who made the diagnosis and the first angioplasty balloon inflation.

Radial aretry injury including intimal tears, dissections, perforation and thrombosis was detected by optical coherence tomography.

Inclusion Criteria: Age ≥ 18 years ST-segment elevation myocardial infarction for primary percuteous coronary intervention Palpable pulses on both access sites of the radial artery Informed consent Exclusion Criteria: Thrombolysis before primary percutaneous coronary intervention Previous CABG or radio-cephalic fistula using radial artery Cardiogenic shock Severe arrhythmias Severe liver and kidney dysfunction Pregnancy Enrolment in another study within 1 month Inability to obtain written informed consent