Arterial Access and Door-to-Balloon Times for Primary Percutaneous Coronary Intervention in Patients Presenting with Acute ST-Elevation Myocardial Infarction Aaron N. Weaver, 1 * MD, Rick A. Henderson, 2 MD, MS, Ian C. Gilchrist, 1 MD, and Steven M. Ettinger, 1 MD Objectives: This study compares the transradial versus the transfemoral approach for time to intervention for patients presenting with ST elevation myocardial infarction (STEMI). Background: Survival following STEMI is associated with reperfusion times (door-to-balloon; D2B). For patients undergoing primary PCI for acute STEMI, potential effects of transradial approach (r-PCI) as compared with the femoral artery approach (f-PCI) on D2B times have not been extensively studied. Methods: Consecutive patients presenting with STEMI at a tertiary care medical center were enrolled in a comprehen- sive—Heart Alert program (HA) and included in this analysis. Time parameters meas- ured included: door-to-ECG, ECG-to-HA activation, HA activation-to-cath lab team ar- rival, patient arrival in cath lab to arterial access, and arterial access-to-balloon infla- tion. Results: Of 240 total patients, 205 underwent successful PCI (n 5 124 r-PCI; n 5 116 f-PCI). No significant difference was observed in the pre-cath lab times. Mean case start times for r-PCI took significantly longer (12.5 6 5.4 min vs. 10.5 6 5.7 min, P 5 0.005) due to patient preparation. Once arterial access was obtained, balloon inflation occurred faster in the r-PCI group (18.3 vs. 24.1 min; P < 0.001). Total time from patient arrival to the cardiac cath lab to PCI was reduced in the r-PCI as compared to the f-PCI group (28.4 vs. 32.7 min, P 5 0.01). There was a small but statistical difference in D2B time (r-PCI 76.4 min vs. f-PCI 86.5 min P 5 0.008). Conclusions: Patients presenting with STEMI can undergo successful PCI via radial artery approach without compromise in D2B times as compared to femoral artery approach. V C 2009 Wiley-Liss, Inc Key words: TRAD—transradial cath; ACS—acute coronary syndrome; PCI— percutaneous coronary intervention INTRODUCTION The site of arterial access for diagnostic and inter- ventional procedures can have a significant impact on the success and outcome of a procedure. Over 60 years ago arterial access using the radial artery was initially described [1], but fell out of favor due to the equipment and technical limitations of the era. Radial artery access for diagnostic cardiac catheterization received renewed interest through the work of Campeau 20 years ago [2], and subsequently for intervention proce- dures by Kiemeneij et al. [3]. Since then, there has been widespread adoption of transradial techniques outside of the United States [4]. In the United States, less than 2% of cardiac catheterizations are performed through the wrist [5]. Reasons stated for slow acceptance in the United States include a lack of training in the radial approach, greater difficulty manipulating catheters, difficulty achieving radial access, uncertain radiation exposure, and a learning curve for performing cardiac catheteri- zation through the wrist [6]. These arguments against the use of the radial artery imply that greater time may be required to perform cardiac catheterization using the 1 Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, Pennsylvania 2 Department of Medicine, Section of Cardiology, Wake Forest University, Baptist Medical Center, Winston-Salem, North Car- olina Conflict of interest: Nothing to report. *Correspondence to: Aaron N. Weaver, MD, 500 University Drive, PO Box 850 H047, Hershey, PA 17033. E-mail: aweaver@hmc.psu. edu Received 26 October 2009; Revision accepted 8 November 2009 DOI 10.1002/ccd.22373 Published online 25 November 2009 in Wiley InterScience (www. interscience.wiley.com) V C 2009 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 75:695–699 (2010)