TY - JOUR
T1 - Brachial approach to emergency cardiac catheterization during thrombolytic therapy for acute Myocardial Infarction
AU - George, Barry S.
AU - Candela, Richard J.
AU - Topol, Eric J.
AU - Stack, Richard S.
AU - Kereiakes, Dean J.
AU - Abbottsmith, Charles W.
AU - Masek, Ramona
AU - Pickel, Ann
AU - Dillon, Joanne
AU - Harrelson, Lynn
AU - Califf, Robert M.
AU - TAMI,
PY - 1990/8
Y1 - 1990/8
N2 - The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704 (28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1 ± 26 min vs. 99.9 ± 133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death (6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9 ± 4.4 and 43.5 ± 4.8, respectively with a nadir of 32.9 ± 5.6 vs. 33.0 ± 5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in the hands of experienced operators the transbrachial approach to acute coronary intervention in the acute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy as the femoral approach.
AB - The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704 (28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1 ± 26 min vs. 99.9 ± 133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death (6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9 ± 4.4 and 43.5 ± 4.8, respectively with a nadir of 32.9 ± 5.6 vs. 33.0 ± 5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in the hands of experienced operators the transbrachial approach to acute coronary intervention in the acute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy as the femoral approach.
KW - cardiac catheterization
KW - coronary intervention
KW - myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=0025146364&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025146364&partnerID=8YFLogxK
U2 - 10.1002/ccd.1810200402
DO - 10.1002/ccd.1810200402
M3 - Article
C2 - 2119888
AN - SCOPUS:0025146364
VL - 20
SP - 221
EP - 226
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 4
ER -