TY - JOUR
T1 - Systematic use of transradial PCI in patients with ST-segment elevation myocardial infarction
T2 - A call to "arms"
AU - Eleid, MacKram F.
AU - Rihal, Charanjit S.
AU - Gulati, Rajiv
AU - Bell, Malcolm R.
PY - 2013/11
Y1 - 2013/11
N2 - A growing body of evidence now supports the use of transradial percutaneous intervention (TRI) as the preferred access site for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Historically, TRI has been avoided in the STEMI population due to concerns over longer procedure time, longer door-to-device time, higher crossover rates, and the experience level required with TRI compared with transfemoral access. However, in recent years, recognition of the impact of periprocedural bleeding on mortality in patients with acute coronary syndromes has garnered interest in the utility of TRI as an established method to reduce bleeding. Registry data, meta-analyses, and randomized control trials all similarly demonstrate that TRI is associated with reduced periprocedural bleeding and lower mortality compared with transfemoral access in the STEMI population. Additional benefits of TRI include enhanced patient comfort, reduced hospital length of stay, and reduced cost. Despite the evidence, trends in use of TRI in the United States have shown a slow adoption rate as a result of multiple barriers in clinical practice and doubts about the mechanism and causal relationship of mortality reduction with TRI. We summarize the current evidence and propose a call to action to foster training of TRI in cardiovascular fellowship programs and post-fellowship courses, and for more widespread implementation of TRI in STEMI patients.
AB - A growing body of evidence now supports the use of transradial percutaneous intervention (TRI) as the preferred access site for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Historically, TRI has been avoided in the STEMI population due to concerns over longer procedure time, longer door-to-device time, higher crossover rates, and the experience level required with TRI compared with transfemoral access. However, in recent years, recognition of the impact of periprocedural bleeding on mortality in patients with acute coronary syndromes has garnered interest in the utility of TRI as an established method to reduce bleeding. Registry data, meta-analyses, and randomized control trials all similarly demonstrate that TRI is associated with reduced periprocedural bleeding and lower mortality compared with transfemoral access in the STEMI population. Additional benefits of TRI include enhanced patient comfort, reduced hospital length of stay, and reduced cost. Despite the evidence, trends in use of TRI in the United States have shown a slow adoption rate as a result of multiple barriers in clinical practice and doubts about the mechanism and causal relationship of mortality reduction with TRI. We summarize the current evidence and propose a call to action to foster training of TRI in cardiovascular fellowship programs and post-fellowship courses, and for more widespread implementation of TRI in STEMI patients.
KW - PCI
KW - STEMI
KW - transradial
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U2 - 10.1016/j.jcin.2013.08.002
DO - 10.1016/j.jcin.2013.08.002
M3 - Review article
C2 - 24262613
AN - SCOPUS:84888107848
SN - 1936-8798
VL - 6
SP - 1145
EP - 1148
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 11
ER -