Post on 13-Jan-2016
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