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Show Radial Access in STEMI Patients-Is it taking too long? A comparison of Radial against Femoral access for Door to Lidocaine, Lidocaine to Sheath, and Sheath to Vascularization times in STEMI Patients Kristen Cornachione M.S. & Theophilus Owan M.D. •Summative Statement: Use of radial access in cardiac catheterization procedures has been shown to have positive impact on reducing bleeding risk, but also lengthened procedure times. We compared two years of STEMI patient data to see if using radial as our default access has had any effect on our procedure times. Contrary to current literature, we found that our procedure times were similar between femoral and radial access. Body of Abstract: •Background: Using radial access for cardiac catheterization procedures has been shown to be associated with lower bleeding risk. However, radial access is thought to have a steeper learning curve resulting in longer procedure time when compared to femoral. We systematically reviewed our institutional experience having made a transition from femoral to radial approach as our default access strategy and here report our catheterization times for both radial and femoral access. •Methods: We approached the topic using National Cardiovascular Data Registry (NCDR) data to compare radial against femoral access. We specifically pulled data from both the ACTION Registry©GWTGTM and CathPCI Registry©. The cohort consisted of all (N=127) consecutive STEMI patients from 2014 through 2015, who underwent cardiac catheterization at UUMC presenting through either emergency services, private vehicle, or transferred from an outside hospital for primary PCI. We divided the cohort into a femoral and radial group and compared means and standard deviations within three subcategories: door to lidocaine, lidocaine to sheath, and sheath to revascularization. •Results: The mean door to lidocaine time for femoral access was 14 min+-7 min, and radial access was 10 min+-6 min. The mean lidocaine to sheath time for femoral access was 2 min+-2 min, and radial access was 1 min+-<1 min. Lastly, mean sheath to revascularization or visualization for femoral access was 21 min+-10 min, and radial access was 19 min+-12 min. •Conclusions: Contrary to existing literature our report shows that procedure times between radial and femoral access were similar. Our ongoing analyses will determine whether any of our quality improvement initiatives had a significant impact on our radial versus femoral catheterization times.. Time (Min) Abstract Door to Lidocaine DeIdentifier 0:14 Physician A 0:15 0:14 0:13 0:12 0:11 0:10 0:09 0:08 0:07 0:06 0:05 0:04 0:03 0:02 0:01 0:00 0:10 Femoral Radial Access Site Figure 1. The mean door to lidocaine time for femoral access was 14 min+-7 min, and radial access was 10 min+-6 min N Percentage radial Lidocaine to Revascularization time Radial (N) Lidocaine to Revascularization time Femoral (N) Arrival to Device Radial Arrival to Device Femoral 26 96% 0:18 (25) 0:09 (1) 0:27 0:18 Physician B 18 78% 0:23 (14) 0:19 (4) 0:38 0:36 Physician C 38 76% 0:21 (29) 0:27 (9) 0:30 0:41 Physician D 24 46% 0:20 (11) 0:13 (13) 0:29 0:26 Physician E 13 54% 0:24 (7) 0:29 (6) 0:33 0:40 Physician F 6 67% 0:17 (4) 0:24 (2) 0:26 0:37 Physician G 1 100% 0:32 (1) n/a 0:50 n/a Table 1. Physician cathlab times and demographics for PPCI in STEMI patients. All physicians in this metric routinely use radial access and have completed a minimum of 50 LHC radial access cases (1). Results The mean door to lidocaine time for femoral access was 14 min+-7 min, and radial access was 10 min+-6 min (Figure 1). The mean lidocaine to sheath time for femoral access was 2 min+-2 min, and radial access was 1 min+-<1 min (Figure 2). Lastly, mean sheath to revascularization or visualization for femoral access was 21 min+-10 min, and radial access was 19 min+-12 min (Figure 3). Physician access preference and cath lab time breakdowns per provider are listed in Table 1. Lidocaine to Sheath 0:03 0:02 Time (Min) 0:01 Background Literature Cited Cardiovasc Revasc Med. 2014 Jun;15(4):195-9. doi: 10.1016/j.carrev.2014.03.001. Epub 2014 Mar 13. Operator learning curve for transradial percutaneous coronary interventions: implications for the initiation of a transradial access program in contemporary US practice. Barbash IM1, Minha S1, Gallino R1, Lager R1, Badr S1, Loh JP1, Kitabata H1, Pendyala LK1, Torguson R1, Satler LF1, Pichard AD1, Waksman R2. Conclusions 0:01 0:00 Femoral Radial Access Site Figure 2. The mean lidocaine to sheath time for femoral access was 2 min+-2 min, and radial access was 1 min+-<1 min Figure 4. Access site choice, radial vs femoral, for use in left heart catheterization procedures. Our cath lab times; door to lidocaine, lidocaine to sheath, and sheath to revascularization, were similar between radial and femoral access. Sheath to Ballon/Visualization 0:22 0:21 0:21 Time (Min) Utilizing radial access in primary PCI (PPCI) has been shown to decrease bleeding risk, morbidity, and mortality in comparison to femoral access (1-4). However, some studies suggest that radial access has a steep learning curve and slower revascularization times (5-6). We aim to understand how switching to radial access has affected our cathlab procedure times. We reviewed data from both the ACTION Registry©GWTGTM and CathPCI Registry©. The cohort consisted of all (N=127) consecutive STEMI patients from 2014 through 2015, who underwent cardiac catheterization at UUMC presenting through either emergency services, private vehicle, or transferred from an outside hospital for primary PCI. We divided the cohort into a femoral and radial group and compared means and standard deviations within three subcategories: door to lidocaine, lidocaine to sheath, and sheath to revascularization. 0:02 0:19 0:20 0:19 0:18 Femoral Radial Access Site Figure 3. The mean sheath to revascularization or visualization for femoral access was 21 min+-10 min, and radial access was 19 min+-12 min. Figure 5. Access site choice, radial vs femoral, for PCI as a percentage. Acknowledgements For Further information |
