# Feasibility and effectiveness of distal radial access in ST-elevation myocardial infarction from a SPEEDY PCI subanalysis

## TL;DR

This study examines whether a less common wrist access method for heart procedures is effective and safe for patients with severe heart attacks.

## Contribution

The study provides new evidence on the feasibility and effectiveness of distal radial access in STEMI patients undergoing PCI.

## Key findings

- dTRA resulted in significantly shorter sheath-to-balloon and door-to-balloon times compared to conventional radial access.
- Procedural success and 30-day mortality rates were similar between dTRA and conventional radial access groups.
- Shorter time metrics may be influenced by institutional practices and operator experience rather than the access site alone.

## Abstract

The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)—where rapid revascularization is critical—remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score–matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7 min, p = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9 min, p = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.