23/4/21 1

TRI vs TFI in STEMI

Shenyang Northern Hospital

Wang Shouli Han Yalin

At the beginning, TRI tended to be avoided in AMI patients----unexpected longer time for arterial cannulation

Many studies have now demonstrated the safety, feasibility and good outcomes of primary PCI performed with TRI, and with a drastic reduction in vascular complications and length of in-hospital stays

Backgrounds

According to guidelines, patients with TFI

undergo aggressive anticoagulation, which

leads eventually to an increased incidence of

bleeding (up to 7%)

However, the combination of GP b/ a Ⅱ Ⅲ

inhibitors and catheterization with TRI is

virtually avoid from serious bleeding

Backgrounds

Why are we reluctant to doTRI for AMI?

• puncture more difficult !

• longer time to ballooning !

• difficult to put IABP balloon !

• not convenience for pacing !

Advantages of TRI for AMI

• Less bleeding complications

• Quick access

• Easy to compress

• Saving the femoral arteries for the

hemodynamic support, if necessary

• Quick ambulation

• Shorter hospital stay

RADIal versus femoral approach for

percutaneous coronary interventions in

patients with Acute Myocardial

Infarction (RADIAMI):A prospective,

randomized, single-center clinical trial

Piotr Chodór, et al.

Cardiol J 2009; 16, 4: 332–340

Flow chart

of patients’

in-hospital

course

Cardiol J 2009; 16, 4: 332–340

Time intervals during coronary angiography and PCI

In-hospital course

The TRI in AMI has the same efficacy as TFI

No differences in total procedure duration, X-ray exposition or volume of contrast

A longer time from the patient’s admission to the individual stages of the PCI procedure in TRI was mostly due to the longer times of the initial stages of the procedure

The use of TRI reduces the time to ambulation and allows rehabilitation to begin sooner

In both groups, bleeding complications occurred rarely

Conclusions:

Hon-Kan Yip,et al. Circ J 2009; 73: 2050 – 2055

Safety and Efficacy of Transradial vs

Transfemoral Arterial Primary

Coronary Angioplasty for Acute

Myocardial Infarction

Single-Center Experience

Hon-Kan Yip,et al. Circ J 2009; 73: 2050 – 2055

TRA TFA

≤Killip 3

TRA TFA

TRA

Initial selection of TRA is not inferior to

initial selection of TFA for AMI patients

undergoing primary PCI

The incidence of combined vascular and

bleeding complications was lower with

the TRA than with the TFA approach

Conclusions:

TRI TFI P valueSuccessful catheterization （%）

494/512(96.5%) 511/512(99.8%) ＜ 0.0001

Median procedural

duration （ min）

37.0(19.6-49.1) 40.2(24.3-50.8) =0.046

median dose area product(Gycm2)

38.2(20.4-48.5) 41.9(22.6-52.2) =0.034

Vascular access site complications %

0.58% 3.71% = 0.0008

Martin Brueck, et al.

JACC: Cardiovascular Interventions, 2009,11(2):1047-1054

A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

Transradial versus transfemoral

percutaneous coronary

intervention in acute myocardial

infarction: Systematic overview

and meta-analysis

Andra´s Vorobcsuk et al. Am Heart J 2009;158:814-21.

3324 patients

Results12 studies involving 3324 patients were identified. TRI reduced major bleeding compared to TFI(P=0.0001),and significant reductions were found in the composite of death, MI,or stroke (P=0.01).Mortality reduction showed a significant toward benefit in the case of TRI(2.04% vs 3.06%, OR 0.54 ｛ 95% CI 0.33-0.86 ｝ ,P=.01).The fluoroscopic time was longer, and access site crossover was more frequent for TRI(P=.001,P

＜ .00001,respectively).

Conclusions

TRI reduces the risk of periprocedural

major bleeding and major adverse

events in the STEMI setting

Andra´s Vorobcsuk et al. Am Heart J 2009;158:814-21.

Our single center data

My personal experience

The introduction of TRI reduces the vascular access site complication

TRI is as feasible as TFI in those patients.

We must read the patient’s history carefully before doing PCI

ECG may help us to identify the target vessel in STEMI or NSTEMI patient before PCI

I suggest TFI if the ECG indicate the target vessel is RCA or LCX

谢谢