Abstract

A paradigm shift demonstrating the feasibility of using the radial artery for primary angioplasty and the evaluation of high-risk subgroups. Materials and methods: The nature of the research may be described as prospective, observational, and descriptive. Patients who presented with acute ST-segment elevation myocardial infarction (STEMI) and were treated with PCI via RA at the cardiology department of a tertiary care centre were included in the study. The interventionist was given complete autonomy in deciding whether to use a RA or FA strategy. Patients who had PCI performed through the femoral artery were not allowed to participate in this research. Patients were hospitalized and underwent evaluation for baseline features such clinical history, physical examination, and investigations such as electrocardiogram, two-dimensional echo, and normal laboratory investigation. After that, patients were separated into two groups for the subgroup analysis: HRG patients and non-HRG patients. Patients with unfavourable characteristics were included in the HRG. These characteristics included age (greater than 80 years), cardiogenic shock, severe left ventricular systolic dysfunction, high degree AV block, low body surface area (BSA), multi-vessel percutaneous coronary intervention (PCI), diabetes mellitus, and low body mass index (BMI). Patients who did not have these characteristics were included in the non-HRG. Results: Males made up 83.33% of the total study population of 150 patients, with 24.67% of those patients being under the age of 50 and 6.67% of those patients being above the age of 80. The body mass index (BMI) was determined, and the results showed that 16.67% of people had a BMI of less than 19 kg/m2, whereas 30% had a BMI of more than 25 kg/m2. The majority of patients had one or more risk factors for Coronary Artery Disease (CAD), with diabetes mellitus in 33.33%, systemic hypertension in 30% and smoking in 16.67%. At presentation, patients average systolic BP was 141.8 ± 24.6 mmHg and diastolic BP was 84.4 ± 12.1 mmHg. Total is chaemic time was found to be 6.55 ± 2.69 hrs for the whole study group. ECG analysis revealed AWMI spectrum in fifty percent of patients, QRBBB pattern in five percent, IWMI spectrum in fifty percent of patients, and RVMI in five percent. According to the results of the echocardiogram, 20% of the patients had a good left ventricular function (LVEF >50%), 40% had mild LV systolic dysfunction (LVEF 40-50%), 20% had moderate LV systolic dysfunction (LVEF 30-40%), and 20% had severe LV systolic dysfunction (LVEF30%). Prior to intervention, coronary angiography revealed the presence of SVD in 40% of patients, DVD in 30%, TVD in 25%, and LMCA involvement in 5% of patients. To treat the other patients, thrombo-suction, bare metal stents (BMS), plain old balloon angioplasty (POBA), and drug-eluting stents (DES) were utilized respectively. Drug-eluting stents were used in the majority of patients (85%). After the operation, TIMI 3 flow was attained in 84.67 percent of cases, TIMI 2 flow in 13.33 percent of cases, and TIMI 1 flow in just 2 percent of cases. The majority of patients, or 89.33%, had fluoroscopy times that were less than 10 minutes during the surgery. The amount of contrast that was administered during the operation was less than 100 ml in 85.33 percent of patients, between 100 and 150 ml in 6 percent of patients, and more than 150 ml in the remaining patients. Conclusion: The purpose of the trial was to investigate the viability of RA in primary angioplasty for patients who had one or more risk factors, the most prevalent of which were diabetes, hypertension, and smoking. Patients who were younger than 50 years had a higher incidence of having a family history of early CAD. When compared to NON-HRG, HRG had a significantly higher incidence of problems; however, this difference was not statistically significant (p value > 0.05).

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