Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction
Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction
Sho Torii 0
Toshiharu Fujii 0
Tsutomu Murakami 0
Gaku Nakazawa 0
Takeshi Ijichi 0
Masataka Nakano 0
Yohei Ohno 0
Norihiko Shinozaki 0
Fuminobu Yoshimachi 0
Yuji Ikari 0
0 Department of Cardiology, Tokai University School of Medicine , 143 Shimokasuya, Isehara 259-1193, Kanagawa , Japan
The purpose of this study is to determine reduction of door-to-balloon (D2B) time using a single universal guiding catheter (Ikari-Left catheter) in transradial approach. In this procedure, we can skip a total of five steps compared with a conventional procedure (two catheter insertions, two catheter removals, and one catheter engagement). Reducing total ischemic time is important to achieving a better outcome in primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). We retrospectively compared 30 consecutive STEMI patients who underwent transradial primary PCI with a single guiding catheter (IL group) with 30 consecutive patients with conventional transradial primary PCI. Patients with cardiogenic shock, heart failure, or need for intra-aortic balloon pumping support before primary PCI were excluded. Baseline characteristics were not different between the two groups. The D2B time was significantly shorter in the IL group (55 ± 16 vs. 63 ± 17 min, respectively; p = 0.01). Puncture-to-balloon time was also significantly shorter in the IL group (15 ± 11 min vs. 25 ± 11 min, respectively; p = 0.001). The total number of diagnostic and guiding catheters was significantly less in IL group (1 (IQR 1-1) vs. 3 (IQR 3-3), respectively; p \ 0.0001). Primary PCI with a single universal guiding catheter reduced D2B time by skipping several procedural steps, and reduced the total number of catheters needed. This technique could reduce patient mortality as well as total medical cost.
Door-to-balloon time; Primary PCI; STEMI; Transradial intervention; Ikari catheter; IL
Introduction
Primary percutaneous coronary intervention (PCI) reduces
the mortality rate in patients with acute ST segment
elevation myocardial infarction (STEMI) [
1, 2
]. Shorter
doorto-balloon (D2B) time has strong association with a lower
mortality rate [
3–5
]. Based on these data, a D2B time of
\90 min has been established as a Class I recommendation
in the current guidelines [
6, 7
]. To reduce the D2B time,
many studies have suggested strategies to reduce
door-tocatheterization laboratory time [
8, 9
]. On the other hand,
there is still room for improvement to reduce
catheterization laboratory-to-balloon time.
Recently, the radial approach in primary PCI has
revealed significant clinical benefits in reducing bleeding
events and morbidity compared with the femoral approach;
however, D2B time with the radial approach was longer
than with the femoral approach [
10, 11
]. Shortening D2B
time using the radial approach would be one way to
improve STEMI patient outcome. A previous study showed
that a high success rate was achieved safely in transradial
PCI using a 6-Fr single universal guiding catheter (IL,
Ikari-Left catheter; Terumo Corporation, Tokyo, Japan) in
elective cases [12]. IL catheter is one of the universal
catheters that is feasible for both transradial and
transfemoral intervention [
13
], for both right and left coronary
artery [
14, 15
], and coronary anomalies like high takeoff.
Thus, we developed a hypothesis that a single universal
guiding catheter can shorten D2B time compared with the
conventional strategy in primary PCI for STEMI.
Methods
Subjects
We retrospectively analyzed 30 consecutive patients with
STEMI who underwent primary PCI with a single universal
guiding catheter (Ikari-left catheter, IL group) at Tokai
University Hospital from January 2013 to May 2015.
Inclusion criteria were: medical consultation \24 h after
symptom onset, chest pain lasting [20 min, ST segment
elevation [1 mm in at least two continuous leads, or new
left bundle branch block. In the same period, 30
consecutive patients who underwent primary PCI with the
transradial approach using diagnostic catheters and a guiding
catheter were enrolled as a control group (Conventional
group). We excluded patients with persistent pulseless
cardiogenic shock, heart failure (Killip [ II), or patients
needing intra-aortic balloon pumping (IABP) support
before the primary PCI. We also excluded patients who
could not perform the transradial approach (radial artery
was not palpable, abnormal Allen’s test result, or
hemodialysis patients with A-V shunt in upper limb).
However, radial approach failure and crossover to a
femoral approach were not reasons for exclusion.
This study complied with the Declaration of Helsinki in
regard to investigation in humans and was approved by the
institutional ethics committees at Tokai University
Hospital. There was no industry (...truncated)