Switching from Femoral to Routine Radial Access Site for ST-Elevation Myocardial Infarction: A Single Center Experience

Objectives This study sought to describe the change of first choice access site from transfemoral (TF) to transradial (TR) in primary percutaneous coronary intervention (pPCI) in a single center. Background TR‐pPCI, when performed by experienced operators, can reduce bleeding events and improve clinical outcome. However, little is known about the learning curve of TR‐pPCI and the results obtained by less experienced operators. Methods Time to reperfusion, contrast and radiation doses, and 30‐day clinical events were evaluated. The relationship between operator experience and procedural results was assessed. Results During 6.5 years, 1,045 patients with STEMI underwent pPCI. The rate of TR‐pPCI increased gradually from about 40% to 90% and remained stable thereafter. The crossover from TR to TFpPCI occurred in 4.6% of patients and was not related to the operator experience. Patients selected for TR‐pPCI had a lower risk profile and lower incidence of 30‐day mortality and bleeding events. Time to reperfusion, contrast volume, fluoroscopy time, and angiographic success was not significantly different between the 2 vascular approaches, nor was it associated to the operator experience. At roughly 200 PCIs as operator experience, a slight adjusted reduction in the time form first coronary angiogram to balloon was detected with both vascular approaches. Conclusions A progressive transition from TF to TR‐pPCI could be implemented over a 4‐year period without increasing overall treatment delay. The impact of operator experience on procedural results appeared to be modest and it did not differ in the study access groups.