Change from radial to femoral access (OR 2.7; 95% CI 1.497-4.985) and vascular kinking or spasm (OR 4.556) were independent predictors of prolonged puncture-wire time in STEMI patients.
Observational (n=1,123)
No
What are the independent predictors of a prolonged puncture-wire time in patients with STEMI undergoing primary PCI?
Procedural complexities such as access site crossover, vascular kinking, need for CPR, and challenging revascularization are independent predictors of prolonged puncture-wire time in STEMI patients.
Odds Ratio: 2.7 (95% CI 1.497–4.985)
p-value: p=<0.001
Abstract Background In patients with STEMI, rapid reperfusion is crucial to achieve optimal outcome. Factors that may influence the puncture-wire time (PWT) have not yet been sufficiently investigated. Methods In a single-center retrospective analysis, all patients presenting with STEMI who underwent primary percutaneous coronary intervention (PCI) over a period of 8 years were analyzed (n=1123). PWT was defined as the time between the first injection of local anesthesia and wire passage of the culprit lesion. Challenging coronary access was defined as the use of more than one catheter to intubate the targeted coronary artery, atypical origin, the presence of an ostial stent, an aneurysm of the ascending aorta as well as any coronary artery anomaly including separate origin of LAD/RCX. Challenging revascularization of the culprit lesion was defined as the need of more than one wire for the passage, the use of a CTO wire as well as microcatheter-assisted or balloon-assisted techniques. Results Patients were categorized into quartiles based on PWT: quartile 1 (≤7 minutes), quartile 2 (7.1-11 minutes), quartile 3 (11.1-17 minutes) and quartile 4 (≥17.1 minutes). Quartile 4 was defined as prolonged PWT. Prolonged PWT was associated with increased frequency of TIMI flow 3 (16.5% vs 10.3%, p=0.009, Fig. 1). No difference was observed in patients´ age (p=0.086), gender (p=0.395), or BMI (p=0.914). Patients with prolonged PWT, more often had a history of CABG (6.1% vs 2.0%, p=0.001), atrial fibrillation (9.3% vs 5.7%, p=0.044), arterial hypertension (73.0% vs 65.2%, p=0.023) and were more often on chronic dialysis (1.5% vs 0.2%, p=0.029). The percentage of patients with a primary radial access showed no significant difference between the groups (prolonged PWT 59.9% vs 65.5%, p=0.109), but multivariable regression analysis revealed a change from radial to femoral access (OR: 2.7, 95% CI: 1.497 – 4.985, p0.001) as well as vascular kinking or spasm (OR: 4.556, 95% CI: 2.264 – 9.166, p0.001) as independent predictors for a longer PWT. Other independent predictors for longer PWT were the need for cardiopulmonary resuscitation during the procedure (OR: 2.4, 95% CI: 1.326 – 4.388, p=0.028) and challenging revascularization of the culprit lesion (OR: 6.2, 95% CI: 3.472 – 11.217, p0.001), whereas the immediate angiography and PCI of the culprit lesion using a guiding catheter without prior complete angiography was independently predictive for a shorter PWT (OR: 0.443, 95% CI: 0.182 – 1.097, p=0.005). Conclusion A preference for the femoral route in patients with a potentially challenging radial access may be advantageous to achieve more rapid revascularization, but must be balanced against a potentially higher rate of bleeding complications. Another possibility to achieve a shorter PWT could be the direct revascularization of the culprit without prior visualizing all main coronary arteries.
Altan et al. (2025) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=1,123). Change from radial to femoral access vs. No change in access route was evaluated on Prolonged puncture-wire time (≥17.1 minutes) (OR 2.7, 95% CI 1.497-4.985, p=<0.001). Change from radial to femoral access (OR 2.7; 95% CI 1.497-4.985) and vascular kinking or spasm (OR 4.556) were independent predictors of prolonged puncture-wire time in STEMI patients.