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Does reducing ischemia time justify to catheterize firstly the culprit artery in every primary PCI?
- Source :
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Heart and vessels [Heart Vessels] 2016 Jul; Vol. 31 (7), pp. 1022-9. Date of Electronic Publication: 2015 Jun 26. - Publication Year :
- 2016
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Abstract
- No consensus exists about which coronary artery should be firstly catheterized in primary PCIs. Initial catheterization of the "culprit artery" could reduce reperfusion time. However, complete knowledge of coronary anatomy could modify revascularization strategy. The objective of the study was to analyze this issue in ST-elevation myocardial infarction patients undergoing primary PCI. PCIs were performed in 384 consecutive patients. Choice of ipsilateral approach (IA): starting with a guiding catheter for the angiography and PCI of the "culprit artery", or contralateral approach (CA): starting with a diagnostic catheter for the "non-culprit artery" and completing the angiography and PCI of the culprit with a guiding catheter was left to the operator. Differences between two approaches regarding reperfusion time, acute events or revascularization strategies were analyzed. There were no differences between two approaches regarding reperfusion time or clinical events. When the left coronary artery was responsible, IA was more frequent (76.4 vs 22.6 %), but when it was the right coronary artery, CA was preferred (20 vs 80 %); p < 0.0001. With CA, bare metal stents (BMS) were more used than drug eluting (DES) (60.8 vs 39.2 %) inversely than with IA (BMS 41.3 vs DES 59.7 %; p < 0.0001). With CA there were more patients with left main or multivessel disease in which revascularization was completed with non-urgent surgery (4.13 vs 2.4 %, p < 0.0001). Initial CA does not involve higher reperfusion time. Furthermore, overall knowledge of coronary anatomy offers more options in revascularization strategy and may imply a change in management. Despite the need to individualize each case, contralateral approach may be the first option with the exception of unstable patients.
- Subjects :
- Aged
Cardiac Catheterization instrumentation
Cardiac Catheters
Coronary Angiography
Drug-Eluting Stents
Female
Hospitals, High-Volume
Humans
Male
Metals
Middle Aged
Patient Selection
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention instrumentation
Predictive Value of Tests
Prosthesis Design
Retrospective Studies
ST Elevation Myocardial Infarction diagnostic imaging
Spain
Stents
Tertiary Care Centers
Time Factors
Treatment Outcome
Cardiac Catheterization methods
Coronary Vessels diagnostic imaging
Percutaneous Coronary Intervention methods
ST Elevation Myocardial Infarction therapy
Time-to-Treatment
Subjects
Details
- Language :
- English
- ISSN :
- 1615-2573
- Volume :
- 31
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Heart and vessels
- Publication Type :
- Academic Journal
- Accession number :
- 26113458
- Full Text :
- https://doi.org/10.1007/s00380-015-0706-9