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Published online: 2022-05-06
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Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from Polish ORPKI registry

Łukasz Piątek1, Karolina Piątek2, Jacek Kurzawski2, Marcin Sadowski1, Krzysztof Malinowski3, Patrycja Cecha1, Stanisław Bartuś3, Zbigniew Siudak1
DOI: 10.33963/KP.a2022.0121
·
Pubmed: 35521715
Affiliations
  1. Collegium Medicum, Jan Kochanowski University, Kielce, Poland
  2. 2nd Department of Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland
  3. 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University in Krakow, Kraków, Poland

open access

Online first
Original article
Published online: 2022-05-06

Abstract

BACKGROUND: Radial artery became preferable access for percutaneous coronary interventions (PCI). Latest European Society of Cardiology guidelines strongly recommended transradial access in ST-segment-elevation myocardial infarction (STEMI) patients. Though, in a significant portion of coronary artery invasive procedures crossover to femoral is necessary.

AIMS: To determine the ratio, risk factors and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry.

METHODS: Based on Polish registry ORPKI data we analyzed 90245 patients with diagnosis of STEMI that were intended to be treated invasively via trans radial access between 2014 and 2019.

RESULTS: In 1484 (1.6 %) individuals a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were: female gender, previous coronary artery by-pass graft, class 3 and 4 of Killip scale, left main disease as well as any complications during coronary angiography. In that cohort the risk of bleeding at the puncture site was over 20-fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, TIMI after PCI and no-reflow) between these groups resulted from disparities in initial characteristics and they were no associated with crossover itself.

CONCLUSIONS: Even though the risk of crossover to femoral is currently low it appears to be indispensable to sustain the operators proficiency both in radial and femoral approach to achieve the best outcomes in these patients.

Abstract

BACKGROUND: Radial artery became preferable access for percutaneous coronary interventions (PCI). Latest European Society of Cardiology guidelines strongly recommended transradial access in ST-segment-elevation myocardial infarction (STEMI) patients. Though, in a significant portion of coronary artery invasive procedures crossover to femoral is necessary.

AIMS: To determine the ratio, risk factors and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry.

METHODS: Based on Polish registry ORPKI data we analyzed 90245 patients with diagnosis of STEMI that were intended to be treated invasively via trans radial access between 2014 and 2019.

RESULTS: In 1484 (1.6 %) individuals a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were: female gender, previous coronary artery by-pass graft, class 3 and 4 of Killip scale, left main disease as well as any complications during coronary angiography. In that cohort the risk of bleeding at the puncture site was over 20-fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, TIMI after PCI and no-reflow) between these groups resulted from disparities in initial characteristics and they were no associated with crossover itself.

CONCLUSIONS: Even though the risk of crossover to femoral is currently low it appears to be indispensable to sustain the operators proficiency both in radial and femoral approach to achieve the best outcomes in these patients.

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Keywords

crossover, transradial access, PCI, STEMI

About this article
Title

Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions — a contemporary report from Polish ORPKI registry

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-05-06

Page views

40

Article views/downloads

15

DOI

10.33963/KP.a2022.0121

Pubmed

35521715

Keywords

crossover
transradial access
PCI
STEMI

Authors

Łukasz Piątek
Karolina Piątek
Jacek Kurzawski
Marcin Sadowski
Krzysztof Malinowski
Patrycja Cecha
Stanisław Bartuś
Zbigniew Siudak

References (22)
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