PMID- 27030600 OWN - NLM STAT- MEDLINE DCOM- 20170703 LR - 20180123 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 102 IP - 12 DP - 2016 Jun 15 TI - Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention. PG - 919-25 LID - 10.1136/heartjnl-2015-308371 [doi] AB - OBJECTIVES: To determine predictors of failure of transradial approach (TRA) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and develop a novel score specific for this population. METHODS: Consecutive patients with STEMI undergoing primary PCI in a tertiary care high-volume radial centre were included. TRA-PCI failure was categorised as primary (primary transfemoral approach (TFA)) or crossover (from TRA to TFA). Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed. Clinical outcomes up to 1 year were assessed. RESULTS: From January 2006 to January 2011, 2020 patients were studied. Primary TRA-PCI failure occurred in 111 (5%) patients and crossover to TFA in 44 (2.2%) patients. Independent predictors of TRA-PCI failure were: weight /=10% conversion to TFA (OR: 2.2; 95% CI 1.2 to 3.7, p=0.005), intra-aortic balloon pump (OR: 2.0; 95% CI 0.9 to 4.3, p=0.066), cardiogenic shock (OR: 2.8; 95% CI 1.4 to 5.6, p=0.0035), endotracheal intubation (OR: 107; 95% CI 42 to 339, p<0.0001), creatinine >133 mumol/L (OR: 3.6; 95% CI 1.9 to 6.8, p<0.0001), age >/=75 (OR: 1.7; 95% CI 1.0 to 2.9, p=0.031), prior PCI (OR: 2.6; 95% CI 1.5 to 4.5, p=0.0009), hypertension (OR: 1.8; 95% CI 1.2 to 2.9, p=0.009). An integer risk score ranging from -1 to 12 was developed, and predicted TRA-PCI failure from 0% to 100% (c-statistic of 0.868; 95% CI 0.866 to 0.869). Mortality at 1 year remained significantly higher after TRA-PCI failure (adjusted OR 2.2; 95% CI 1.2 to 3.9, p=0.011). CONCLUSIONS: In a high-volume radial centre, the incidence of TRA-PCI failure is low and can be accurately predicted using a 9-variables risk score. Since outcomes after TRA-PCI failure remained inferior, further effort to maximise the use of radial approach for primary PCI should be investigated. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ FAU - Abdelaal, Eltigani AU - Abdelaal E AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - MacHaalany, Jimmy AU - MacHaalany J AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Plourde, Guillaume AU - Plourde G AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Barria Perez, Alberto AU - Barria Perez A AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Bouchard, Marie-Pier AU - Bouchard MP AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Roy, Melanie AU - Roy M AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Dery, Jean-Pierre AU - Dery JP AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Dery, Ugo AU - Dery U AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Barbeau, Gerald AU - Barbeau G AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Larose, Eric AU - Larose E AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Gleeton, Onil AU - Gleeton O AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Noel, Bernard AU - Noel B AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Rodes-Cabau, Josep AU - Rodes-Cabau J AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Roy, Louis AU - Roy L AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Costerousse, Olivier AU - Costerousse O AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. FAU - Bertrand, Olivier F AU - Bertrand OF AD - Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160330 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM CIN - Heart. 2016 Jun 15;102(12):897-8. PMID: 27067359 MH - Aged MH - Cardiac Catheterization/*adverse effects/methods/mortality MH - Decision Support Techniques MH - Female MH - Hospitals, High-Volume MH - Humans MH - Kaplan-Meier Estimate MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio MH - Percutaneous Coronary Intervention/*adverse effects/methods/mortality MH - Predictive Value of Tests MH - Punctures MH - Quebec MH - *Radial Artery/diagnostic imaging MH - Risk Assessment MH - Risk Factors MH - ST Elevation Myocardial Infarction/diagnostic imaging/mortality/*therapy MH - Tertiary Care Centers MH - Time Factors MH - Treatment Failure EDAT- 2016/04/01 06:00 MHDA- 2017/07/04 06:00 CRDT- 2016/04/01 06:00 PHST- 2015/07/22 00:00 [received] PHST- 2016/03/02 00:00 [accepted] PHST- 2016/04/01 06:00 [entrez] PHST- 2016/04/01 06:00 [pubmed] PHST- 2017/07/04 06:00 [medline] AID - heartjnl-2015-308371 [pii] AID - 10.1136/heartjnl-2015-308371 [doi] PST - ppublish SO - Heart. 2016 Jun 15;102(12):919-25. doi: 10.1136/heartjnl-2015-308371. Epub 2016 Mar 30.