Single catheter primary percutaneous coronary intervention method in patients with ST-elevation myocardial infarction: the SPEEDY-PCI study

Abstract

Reducing total ischemic time in ST-elevation myocardial infarction (STEMI) is crucial for improving outcomes. While procedural time during primary percutaneous coronary intervention (PCI) is critical, strategies to shorten it need to be explored. To examine whether the single-catheter PCI (SC-PCI) method using a universal guiding catheter, Ikari-Left curve, without catheter exchange reduces PCI time compared to conventional PCI (C-PCI). The Speedy PCI study is a prospective, multicenter, randomized trial comparing SC-PCI versus C-PCI. The primary endpoint was the time from sheath insertion to first device activation (S2B) time. Secondary endpoints included door-to-balloon time, total ischemia time, fluoroscopy time, contrast volume, hospital expenses, and 30-day mortality. A total of 380 patients (SC-PCI: 194; C-PCI: 186) were analyzed. Both groups had high primary PCI success rates (92.3 vs. 91.9%, p = 0.74) and similar radial access usage (higher than 97%). SC-PCI method showed a significantly shorter S2B time (15.8 ± 10.9 min) compared to the C-PCI method (18.7 ± 10.6 min, p = 0.007) with reduced number of total catheters used (1.2 ± 0.6 vs. 2.7 ± 0.7, p < 0.0001, respectively). No cases of coronary dissection caused by the guiding catheter were observed in the SC-PCI method. Clinical outcomes at 30 days and 1-year follow-up, including all-cause mortality and stroke rates, were similar between the groups. The SC-PCI method using the Ikari curve demonstrated a significant reduction in PCI procedure time while maintaining safety and primary PCI success in primary PCI for STEMI.

Keywords: Ikari curve; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Single-catheter PCI.