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

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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.

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