Single Catheter Use as the Default Approach for Coronary Angiography and Intervention in Patients with ST-Elevation Myocardial Infarction

Background/Objectives: Transradial access (TRA) is a standard approach in the management of ST-segment elevation myocardial infarction (STEMI); however, evidence on using a single catheter for both diagnostic angiography and percutaneous coronary intervention (PCI) is limited. This study evaluates the feasibility and clinical outcomes of using a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients. Methods: A total of 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were included. Procedural success was defined as completing both diagnostic coronary angiography and PCI without catheter exchange. Procedural characteristics and access-site complications were evaluated. Results: The success rate of completing diagnostic angiography and PCI using a single JL 3.5 guiding catheter without catheter exchange was 91.1%. Compared to procedures requiring multiple catheters, the single-catheter group had significantly lower total contrast volume (200 vs. 250 mL), procedure time (20 vs. 30 min), fluoroscopy time (10.3 vs. 17.6 min), radiation dose (358 vs. 545 mGy), and needle-to-balloon time (6 vs. 9 min), all with p < 0.001. Access-site complications were also lower (8.2% vs. 15.8%; p = 0.010), primarily due to reduced radial artery spasm (4.0% vs. 12.9%; p = 0.001). Conclusions: A single JL 3.5 catheter strategy via transradial access is a safe, efficient, and effective method for STEMI intervention, offering significant procedural and clinical advantages.