الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Worldwide, ischemic heart disease is the single most common cause of death and its frequency is increasing.
For patients with the clinical presentation of STEMI within 12 h after symptom onset, early mechanical (PCI) or pharmacological reperfusion should be performed.
Thrombolytic therapy to abort a myocardial infarction is not always effective. Failure rates of thrombolytic can be as high as 20% or higher.
There is compelling evidence of better clinical outcomes with primary percutaneous coronary intervention (PCI) compared with thrombolysis in patients presenting with acute STEMI.
Primary PCI has contributed to improve mortality. Further reduction of mortality has been observed with improvement of anti-thrombotic therapies.
The benefits of powerful antithrombotic therapies may be reduced by bleeding complications, therefore large interests have been focused on strategies to prevent bleeding complications.
Transradial percutaneous coronary intervention has gained wide-spread acceptance. With a major advantage of the near elimination of clinically significant access site complications, even in patients at high risk (i.e., patients treated with Gp IIb/IIIa inhibitors or shortly after systemic thrombolysis). However, these benefits may potentially be counterbalanced by the possible greater occurrence of procedural failure and longer procedural times due to difficulty in puncturing the radial artery, inability to cannulate the coronaries, or impossibility to perform the angioplasty, all factors that raise concerns as to whether radial access remains beneficial in the setting where timely reperfusion is critical.
The aim of this study is to compare the procedural and clinical outcomes of patients undergoing PCI whether primary or rescue for STEMI using trans radial versus trans femoral approach as regard to net adverse clinical outcome [death, myocardial reinfarction, stroke, major bleeding and vascular access site complications], vascular access site cross over, and duration of intensive care stay.
The study population consisted of 200 patients presented with STEMI and treated with primary or Rescue PCI divided into 2 groups with 100 patients underwent PCI by radial approach and the other 100 patients by femoral approach.
All patients were subjected to detailed history taking, clinical evaluation, ECG analysis and laboratory investigations.
Chest pain to time of first medical contact (FMC), time of FMC to STEMI diagnosis and time from STEMI diagnosis to reperfusion (puncturing time, from end of puncturing to vessel engagement, and the procedural time were computed.
Coronary angiography and PCI procedure were described including materials used and the intra-procedure complications were also documented. Patients were put under observation to detect the occurrence of any in-hospital MACE or other hemodynamic complications.