Evaluation of Learning Curve of Trans-Radial Percutaneous Coronary Angioplasty in Stemi- A Single Centre, Observational Study

Background: Percutaneous Transluminal Coronary Angioplasty (PTCA) through radial route is known to have a steep learning curve. The impact of this results in hesitation of performing PTCA through radial route by conventional femoral access operators. Objective: This study was designed to evaluate the difficulties and problems related to learning of radial PTCA by a team trained with PTCA by femoral route. Methods: In this prospective longitudinal study, over duration of 6 months we enrolled consecutive patients of acute STEMI (ST segment elevation myocardial infarction). All patients presenting within the window period of primary PTCA (up to 12 hours from onset of chest pain) or patients with ongoing chest pain or new ECG changes or hemodynamic compromise beyond 12 hours after the onset of chest pain were considered eligible for primary PTCA and were enrolled for transradial intervention. Thrombolysed patients were excluded. The team members involved in the study was trained for trans-femoral PTCA and was doing transfemoral PTCA for both primary and elective cases for 3 years to 6 years. Results: Over duration of 6 months, primary PTCA was performed in total of 30 patients of acute STEMI. Success rate of the trans-radial PTCA procedure was 97%. Cross-over rate to trans-femoral PTCA was 3%. The mortality rate was 3%, which was the incidence of radial artery stenosis. Conclusion: The study documents the ease of PTCA through trans-radial route even with operators trained with conventional femoral approach. Although our data is exclusively from primary PTCA in STEMI, but it can be applicable to routine elective PTCA also.