Safety and Efficacy of Using a Single Transradial MAC Guiding Catheter for Coronary Angiography and Intervention in Patients with ST Elevation Myocardial Infarction

Abstract

Background: There are limited data on the impact of using a single dedicated radial guiding catheter in primary percutaneous coronary intervention (PCI) via radial access. Objectives: To investigate the effect of using a single guiding catheter (MAC 3.5) for left and right coronary angiography and intervention on catheterization laboratory door to balloon (C2B) time in patients with ST elevation myocardial infarction (STEMI). Methods: Three hundred and sixty patients were randomized (1:1) to using a single MAC3.5 guiding catheter (MAC group) or diagnostic Tiger catheter first for coronary angiography followed by guiding catheter selection (control group) for intervention. The primary outcomes were C2B. The secondary outcomes were major adverse cardiac events (MACE) at 30 days and 6 months. Results: Median C2B time (16.6 min, interquartile range [IQR] 14.3–20.2 min vs 19.0 min, IQR 14.3–23.1 min; P < 0.001), total procedure time (31.0 min, IQR 26.4–37.7 min vs 34.8 min, IQR 29.7–42.5 min, P < 0.001), and overall fluoroscopy time (8.0 min, IQR 6.4–10.4 min vs 8.8 min, IQR 6.5–12.2, P = 0.04) were significantly reduced in MAC Group. Contrast consumption were similar among both groups (103 ± 37 ml vs 110 ± 41 ml, P = 0.16). The MACE rate in MAC group and control group was 3.3 versus 4.4% (P = 0.586) at 30 days and 3.3 versus 5.0% (P = 0.429) at 6 months, respectively. Conclusions: A single MAC3.5 guiding catheter for coronary angiography and intervention can shorten C2B time, procedure time, and fluoroscopy time. (RAPID study; NCT01759043).