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Background <p>In patients with ST-elevation myocardial infarction (STEMI), rapid reperfusion is essential for optimal outcomes, yet factors influencing intraprocedural delays remain insufficiently investigated.</p> Methods <p>In this single-center retrospective study, consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) between 2015 and 2024 were analyzed. Prolonged time between vascular puncture and wire passage (puncture-wire time; PWT) was defined as a value in the fourth quartile of the study population (&gt;17.1 minutes). Multivariable logistic regression identified independent predictors and procedural determinants of prolonged PWT.</p> Results <p>A total of 1,235 patients (70.7% male, median age 64.5 years [IQR 56.0–75.25]) were included. Radial-to-femoral access crossover (OR 2.539, 95% CI 1.381–4.665, p = 0.003), arterial kinking or severe radial spasm (OR 3.669, 95% CI 1.986–6.778, p &lt; 0.001) and challenging revascularization of the culprit lesion (OR 2.330, 95% CI 1.319–4.116, p = 0.004) were independently associated with prolonged PWT. Direct intervention of the culprit lesion was independently associated with a lower likelihood of prolonged PWT (OR 0.445, 95% CI 0.201 – 0.988, p = 0.047). In contrast, the primary choice of vascular access (radial vs. femoral) was not associated with prolonged PWT (p=0.06).</p> Conclusion <p>While some factors are system- or patient-dependent, early recognition of procedural difficulties and individualized access-site decision making may help minimize procedural delays. In selected patients, a primary femoral access route may be considered, and direct intervention of the culprit lesion should be pursued to minimize PWT.</p> Clinical trial number <p>Not applicable.</p>

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Predictors of a prolonged puncture-wire time in patients with ST-Elevation Myocardial Infarction (STEMI)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Merve Günes-Altan,
  • Stephan Achenbach,
  • Johannes Michael Altstidl,
  • Maximilian Moshage,
  • Henry Strupp,
  • Lennart Lorenz,
  • Stephan Scholl,
  • Mohamed Marwan,
  • Monique Troebs,
  • Luise Gaede

摘要

Background

In patients with ST-elevation myocardial infarction (STEMI), rapid reperfusion is essential for optimal outcomes, yet factors influencing intraprocedural delays remain insufficiently investigated.

Methods

In this single-center retrospective study, consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) between 2015 and 2024 were analyzed. Prolonged time between vascular puncture and wire passage (puncture-wire time; PWT) was defined as a value in the fourth quartile of the study population (>17.1 minutes). Multivariable logistic regression identified independent predictors and procedural determinants of prolonged PWT.

Results

A total of 1,235 patients (70.7% male, median age 64.5 years [IQR 56.0–75.25]) were included. Radial-to-femoral access crossover (OR 2.539, 95% CI 1.381–4.665, p = 0.003), arterial kinking or severe radial spasm (OR 3.669, 95% CI 1.986–6.778, p < 0.001) and challenging revascularization of the culprit lesion (OR 2.330, 95% CI 1.319–4.116, p = 0.004) were independently associated with prolonged PWT. Direct intervention of the culprit lesion was independently associated with a lower likelihood of prolonged PWT (OR 0.445, 95% CI 0.201 – 0.988, p = 0.047). In contrast, the primary choice of vascular access (radial vs. femoral) was not associated with prolonged PWT (p=0.06).

Conclusion

While some factors are system- or patient-dependent, early recognition of procedural difficulties and individualized access-site decision making may help minimize procedural delays. In selected patients, a primary femoral access route may be considered, and direct intervention of the culprit lesion should be pursued to minimize PWT.

Clinical trial number

Not applicable.