Distal radial access reduced sheath-to-balloon time to 12.5 min versus 19.7 min (p=0.002) compared to conventional radial access in STEMI patients undergoing PCI.
RCT (n=370)
Open-label
Randomized for parent SPEEDY PCI study; access site not randomized for this subanalysis
Yes
Does the distal radial approach improve procedural time metrics compared to the conventional radial approach in STEMI patients undergoing primary PCI?
The distal radial approach is a feasible and safe alternative to the conventional radial approach for primary PCI in STEMI patients, potentially offering shorter procedural times when performed by experienced operators.
Effect estimate: p=0.002
Absolute Event Rate: 12.5% vs 19.7%
p-value: p=0.002
Abstract The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)—where rapid revascularization is critical—remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score–matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7 min, p = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9 min, p = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.
Nakagami et al. (2026) conducted an RCT in Patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention via distal or conventional radial access (n=370). Distal radial approach (dTRA) vs. Conventional radial approach was evaluated on Sheath-to-balloon time (time from sheath insertion to balloon inflation) (p=0.002, p=0.002). Distal radial access reduced sheath-to-balloon time to 12.5 min versus 19.7 min (p=0.002) compared to conventional radial access in STEMI patients undergoing PCI.