Distal Versus Conventional Transradial Artery Access for Coronary Catheterization in Patients With STEMI (DR-STEMI)

Distal Versus Conventional Transradial Artery Access for Coronary Catheterization in Patients With STEMI

Distal Versus Conventional Transradial Artery Access for Coronary Catheterization in Patients With ST-elevation Myocardial Infraction (STEMI): The DR-STEMI Trial

Recently, a novel distal transradial, through anatomical snuffbox, approach has been proposed for undertaking percutaneous coronary angiography and interventions. The existing literature has evaluated distal transradial access (dTRA) as a feasible and safe approach, with faster hemostasis, lower rates of periprocedural complications and reduced incidence of radial artery occlusion (RAO). Aim of the present study is to compare dTRA versus conventional TRA access in patients with STEMI undergoing coronary angiography and interventions regarding peri- and post-procedural characteristics.

Gaining vascular access is the first, mandatory step for undertaking percutaneous coronary angiography and interventions. The recent guidelines, published by European Society of Cardiology (ESC), American College of Cardiology (ACC), American Heart Association (AHA) and Society for Cardiovascular Angiography and Interventions (SCAI), propose TRA as the gold standard for acute coronary syndromes (ACS), chronic coronary syndrome (CCS) percutaneous coronary interventions (PCI). Recently, a novel distal transradial, through anatomical snuffbox, approach has been proposed. The existing literature has evaluated distal transradial access (dTRA) as a feasible and safe approach, with faster hemostasis, lower rates of periprocedural complications and reduced incidence of radial artery occlusion (RAO). Mutual point of all the previous RCTs is that excluded patients suffering from ST-elevation Myocardial Infraction (STEMI). Aim of the present study is to compare dTRA versus conventional TRA access in patients with STEMI undergoing coronary angiography and interventions regarding peri- and post-procedural characteristics.

ST Elevation Myocardial Infarction, Coronary Artery Disease, Distal Transradial Artery, Transradial Artery, Coronary Catheterization, Percutaneous Coronary Intervention, Primary PCI

ST Elevation Myocardial Infarction, Coronary Artery Disease, distal transradial artery, transradial artery, coronary catheterization, percutaneous coronary intervention, primary PCI

Vascular access after cannulation of distal transradial artery through anatomical snuffbox for coronary angiography and interventions

Vascular access after puncturing on the conventional transradial artery for performing coronary angiography and interventions

Radial artery patency evaluation with Doppler ultrasound prior to hospital discharge for detecting possible occlusion after cannulation

The evaluation will be performed during hospitalization for STEMI and prior discharge, typically the 4th day after PCI

The time interval between the initiation of radial artery puncture and the completion of coronary angiography, until the beginning of the possible PCI

The time interval between the initiation of radial artery puncture and the completion of coronary angiography, until the beginning of the possible PCI

Inclusion Criteria: Age > 18 years old Indication: ST-Elevation Myocardial Infraction Exclusion Criteria: Non-palpable radial artery Previous CABG Anatomical restrictions for forearm approach Hemodynamic instability Previous radial artery catheterization from the same arm during the last 30-days

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Tsigkas G, Papageorgiou A, Moulias A, Apostolos A, Kalogeropoulos AP, Davlouros P. Reply: Distal Transradial Access for Primary PCI in ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2022 Apr 11;15(7):795-796. doi: 10.1016/j.jcin.2022.02.039. No abstract available.

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Tsigkas G, Apostolos A, Davlouros P. Less Is More, But Not Always: Distal Transradial Access for Radial Artery Occlusion Prevention. JACC Cardiovasc Interv. 2022 Jun 27;15(12):1202-1204. doi: 10.1016/j.jcin.2022.05.001. Epub 2022 May 17. No abstract available.