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<p>The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)—where rapid revascularization is critical—remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score–matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7&#xa0;min, <i>p</i> = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9&#xa0;min, <i>p</i> = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.</p>

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Feasibility and effectiveness of distal radial access in ST-elevation myocardial infarction from a SPEEDY PCI subanalysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月17日

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  • Akihiko Takahashi,
  • Sho Torii,
  • Yujiro Ono,
  • Masanori Taniwaki,
  • Mitsutoshi Oguri,
  • Masanori Teramura,
  • Ryuichi Kato,
  • Shuji Otsuki,
  • Hiroshi Suzuki,
  • Fuminobu Yoshimachi,
  • Hironori Ueda,
  • Keisuke Shioji,
  • Gaku Nakazawa,
  • Kaoru Sakurai,
  • Mitsuru Tsujimoto,
  • Motosu Ando,
  • Toshiyuki Kozai,
  • Rie Aoyama,
  • Yuji Ikari

摘要

The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)—where rapid revascularization is critical—remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score–matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7 min, p = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9 min, p = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.