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Does reducing ischemia time justify to catheterize firstly the culprit artery in every primary PCI?

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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.

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Abbreviations

STEMI:

ST-elevation myocardial infarction

PPCI:

Primary percutaneous coronary intervention

DTB:

Door to balloon

ATB:

Access to ballon

LM:

Left main

CABG:

Coronary artery bypass grafting

IA:

Ipsilateral approach

CA:

Contralateral approach

RCA:

Right coronary artery

LCA:

Left coronary artery

BMS:

Bare metal stent

DES:

Drug eluting stent

DAPT:

Dual antiplatelet therapy

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Authors and Affiliations

  1. Cardiology Department, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n, 28026, Madrid, Spain

    Alfonso Jurado-Román, Julio García-Tejada, Felipe Hernández-Hernández, Carolina Granda-Nistal, Belén Rubio-Alonso, Maite Velázquez-Martín, Agustín Albarrán-González-Trevilla & Juan Tascón-Pérez

  2. Cardiology Department, Hospital Infanta Leonor, Madrid, Spain

    Pilar Agudo-Quílez

Authors
  1. Alfonso Jurado-Román
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  2. Julio García-Tejada
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  3. Felipe Hernández-Hernández
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Correspondence to Alfonso Jurado-Román.

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Jurado-Román, A., García-Tejada, J., Hernández-Hernández, F. et al. Does reducing ischemia time justify to catheterize firstly the culprit artery in every primary PCI?. Heart Vessels 31, 1022–1029 (2016). https://doi.org/10.1007/s00380-015-0706-9

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  • DOI: https://doi.org/10.1007/s00380-015-0706-9

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