Effect of Transbrachial Arterial Approach on the Outcome of Percutaneous Coronary Intervention in Patients With ST-segment Elevation Myocardial Infarction

Objective To study the effect of the transbrachial artery approach on the success rate of puncture, revascularization time, and postprocedural complications in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI).

Methods The clinical data of 324 patients with STEMI who underwent PCI between September 2020 and May 2024 at our hospital were retrospectively analyzed. According to the different approaches, the patients were divided into a brachial artery group (127 cases) and a radial artery group (197 cases). Their procedural parameters (X-ray exposure time, contrast agent dosage, puncture time, puncture success rate, and revascularization time) and hospital length-of-stay, cardiac function indicators, including left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI), before surgery and 3 months after PCI, and the incidence of complications were compared between the two groups of patients. Furthermore, a difference-in-differences method was adopted for the logistic model to evaluate the effects of different approaches.

Results There were no statistical differences in the general data between the brachial artery group and the radial artery group. Compared with those of the radial artery group, the revascularization time and length-of-stay of the brachial artery group were shortened, and the success rate of puncture was increased (P < 0.05). There were no significant differences in X-ray exposure time or contrast agent dosage between the two groups. The changes in LVEF, LVFS, LVESVI, and LVEDVI from baseline to 3 months post-PCI were (10.97 ± 7.15)%, (3.29 ± 5.90)%, (22.11 ± 9.30) mL/m², and (18.13 ± 6.68) mL/m², respectively, in the brachial artery group, while those in the radial artery group were (10.61 ± 7.13)%, (4.38 ± 6.04)%, (23.13 ± 9.60) mL/m², and (19.34 ± 7.27) mL/m², respectively, without statistical differences. Difference-in-differences analysis revealed that there were no statistical differences in the effects of different approaches on LVEF, LVFS, LVESVI, and LVEDVI between the brachial artery group and the radial artery group. During follow-up, no complications, such as coronary perforation, coronary dissection, or stent thrombosis, were observed in either group, and there were no statistical differences in the complication incidence between the two groups.

Conclusion The transbrachial artery approach can shorten the revascularization time and length-of-stay of patients with STEMI treated by PCI. It has a high success rate of puncture and can promote the recovery of postoperative cardiac function without increasing postoperative complications.