Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
Singapore Med J. 2011 Apr;52(4):257-62.
Primary transradial percutaneous coronary intervention (TRI) is shown to be efficacious in stable patients with acute coronary syndrome. We aimed to evaluate the application of primary TRI for acute ST elevation myocardial infarction (STEMI), including among high-risk patients from our registry.
This was a single-centre case series comprising 138 patients who underwent primary TRI for STEMI between May 2007 and June 2008. TRI was attempted with a 6-Fr guiding catheter in all patients regardless of Killip class status. Outcome measures were success rates of primary TRI, door-to-balloon time, procedure duration and volume of contrast used. All patients were followed up for major adverse cardiac events in-hospital, at 30 days and six months.
A total of 138 patients had primary TRI attempted for STEMI. Four patients failed primary TRI and required a femoral approach. The remaining 134 patients underwent primary TRI. The mean patient age was 56.4 years. Most patients with acute STEMI presented in Killip class I and II (91.8 percent). Only 8.2 percent were in Killip class III or IV on admission. 50 percent of patients presented with anterior STEMI. The median door-to-balloon time for this group was 92 (interquartile range [IQR] 77-121) minutes, with a median procedure time of 39 (IQR 29-51) minutes. The success rate of primary TRI was 97.1 percent.
Success rate, procedural and radiation time for TRI are comparable to those achieved via the femoral approach. Primary TRI is therefore a feasible and effective approach for acute STEMI, even in high-risk patients.
经桡动脉入路行直接经皮冠状动脉介入治疗（TRI）已被证实对急性冠状动脉综合征稳定型患者有效。我们旨在评估原发性 TRI 在急性 ST 段抬高型心肌梗死（STEMI）中的应用，包括我们注册中心的高危患者。
这是一项单中心病例系列研究，共纳入 138 例于 2007 年 5 月至 2008 年 6 月期间因 STEMI 行直接 TRI 的患者。所有患者均尝试使用 6Fr 引导导管进行 TRI，无论 Killip 分级状态如何。主要观察终点为原发性 TRI 的成功率、门球时间、手术时间和造影剂用量。所有患者均进行院内、术后 30 天和 6 个月的主要不良心脏事件随访。
共有 138 例患者因 STEMI 行直接 TRI。4 例患者因原发性 TRI 失败而改行股动脉入路。其余 134 例患者成功接受了原发性 TRI。患者平均年龄为 56.4 岁。大多数急性 STEMI 患者就诊时 Killip 分级为 I 级和 II 级（91.8%）。入院时仅 8.2%的患者为 Killip 分级 III 级或 IV 级。50%的患者表现为前壁 STEMI。该组患者的中位门球时间为 92（四分位距 [IQR] 77-121）分钟，中位手术时间为 39（IQR 29-51）分钟。原发性 TRI 的成功率为 97.1%。
TRI 的成功率、手术时间和辐射时间与股动脉入路相当。因此，原发性 TRI 是急性 STEMI 的一种可行且有效的方法，即使在高危患者中也是如此。
