Scholarlink

Background <p>Compared with conventional transradial access (TRA), distal radial access (DRA) is rarely used for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and may be beneficial to prevent radial artery occlusion (RAO). We aimed to evaluate the incidence of RAO between DRA and TRA 24&#xa0;h after primary PCI in patients with STEMI.</p> Methods <p>This is a single-center, open-label, prospective, randomized controlled trial conducted at Beijing Luhe Hospital, China, between January 2022 and July 2023. Five hundred and twenty patients (mean age: 61.3 ± 13.0&#xa0;years; 81% male) with STEMI were randomly assigned to the DRA (<i>n</i> = 260) or TRA (<i>n</i> = 260) group. Primary PCI was performed using the radial artery access assigned study group. The primary endpoint was the rate of RAO assessed using Doppler ultrasound 24&#xa0;h after primary PCI. Secondary outcomes included time taken for sheath insertion, access success rate, hemostasis time, fluoroscopy time, radiation dosage, and access-related complications.</p> Results <p>The incidence of RAO was significantly lower in the DRA group than that in the TRA group (1.9% vs. 8.5%, <i>P</i> = 0.001). Access was successful in 94.6% of patients, and the crossover rate was 5.4% in both groups. The median time taken for sheath insertion was significantly longer (133&#xa0;s vs. 114&#xa0;s, <i>P</i> = 0.009), whereas the mean hemostasis time was shorter (209 ± 71&#xa0;min vs. 372 ± 70&#xa0;min, <i>P</i> &lt; 0.001) in the DRA group. The incidence of modified Early Discharge After Transradial Stenting of Coronary Arteries (mEASY) ≥ II hematoma was lower in the DRA group (0.8% vs. 3.5%, <i>P</i> = 0.033). However, there was no significant difference in fluoroscopy time, radiation dosage, or access-related complications.</p> Conclusions <p>In patients with STEMI undergoing primary PCI, compared with TRA, DRA prevented RAO 24&#xa0;h postoperatively and was associated with shorter hemostasis time and a lower incidence of mEASY ≥ II hematoma.</p> Trial registration <p>Clinical Trials.gov Identifier: NCT05461781.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Distal radial access to prevent radial artery occlusion for STEMI patients (RAPID III): a randomized controlled trial

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年3月24日

查看全文
  • Zixuan Li,
  • Yujie Wang,
  • Jiahui Song,
  • Senhu Wang,
  • Yuntao Wang,
  • Yongxia Wu,
  • Haotian Wang,
  • Zijing Liu,
  • Rui Yan,
  • Guangyao Zhai,
  • Jincheng Guo

摘要

Background

Compared with conventional transradial access (TRA), distal radial access (DRA) is rarely used for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and may be beneficial to prevent radial artery occlusion (RAO). We aimed to evaluate the incidence of RAO between DRA and TRA 24 h after primary PCI in patients with STEMI.

Methods

This is a single-center, open-label, prospective, randomized controlled trial conducted at Beijing Luhe Hospital, China, between January 2022 and July 2023. Five hundred and twenty patients (mean age: 61.3 ± 13.0 years; 81% male) with STEMI were randomly assigned to the DRA (n = 260) or TRA (n = 260) group. Primary PCI was performed using the radial artery access assigned study group. The primary endpoint was the rate of RAO assessed using Doppler ultrasound 24 h after primary PCI. Secondary outcomes included time taken for sheath insertion, access success rate, hemostasis time, fluoroscopy time, radiation dosage, and access-related complications.

Results

The incidence of RAO was significantly lower in the DRA group than that in the TRA group (1.9% vs. 8.5%, P = 0.001). Access was successful in 94.6% of patients, and the crossover rate was 5.4% in both groups. The median time taken for sheath insertion was significantly longer (133 s vs. 114 s, P = 0.009), whereas the mean hemostasis time was shorter (209 ± 71 min vs. 372 ± 70 min, P < 0.001) in the DRA group. The incidence of modified Early Discharge After Transradial Stenting of Coronary Arteries (mEASY) ≥ II hematoma was lower in the DRA group (0.8% vs. 3.5%, P = 0.033). However, there was no significant difference in fluoroscopy time, radiation dosage, or access-related complications.

Conclusions

In patients with STEMI undergoing primary PCI, compared with TRA, DRA prevented RAO 24 h postoperatively and was associated with shorter hemostasis time and a lower incidence of mEASY ≥ II hematoma.

Trial registration

Clinical Trials.gov Identifier: NCT05461781.