Osceola Regional Debuts Novel Approach for STEMI via Patient’s Wrist

KISSIMMEE—Orlando-area residents who have a heart attack may find life-saving relief with some innovative wrist action.

Patients that have experienced the shock of a heart attack may find relief thanks to a unique procedure by which doctors can now unblock arteries quickly through the radial artery.

Local EMTs that diagnose patients with STEMI (ST-segment elevation myocardial infarction) are able to immediately transfer patients with “Code STEMI” to the cardiac catheterization at the Central Florida Cardiac and Vascular Institute for this approach.

Atul Madan, MD, Harvard-trained in cardiovascular care, leads the radial STEMI  procedures. Madan and a multidisciplinary team are able to unclog the blood vessel that causes the heart attack in less than 90 minutes, the national standard time to save the heart muscle and prevent heart failure.

“Our goal is to remain at the forefront of cardiovascular care,” explained Osceola Regional CEO Kathryn Gillette. “Providing our community the best in cardiac and vascular care is our top priority.”

This successful radial artery coronary angioplasty in STEMI is relatively new and used only in very few centers nationwide. One hazy March morning, Madan performed the first STEMI procedure through radial artery at the Cardiac and Vascular Institute. For the past eight months, this has been his preferred approach for acute and non-acute heart catheterizations.

“This procedure has several advantages over the standard cardiac catheterization procedure, which in a majority of cases is performed through the femoral artery in the groin,” explained Madan, who has performed at least a half-dozen radial STEMIs since then. “The choice of patients is an as-it-comes basis. No fixed selection criteria are laid out at present. Essentially, the radial artery approach is chosen for those patients who cannot be accessed from the femoral artery or those for whom risks of femoral catheterization outweigh its benefits.”

STEMIs are treated with balloon angioplasty and stent procedures. Balloon angioplasty requires the insertion of a catheter into the patient’s artery and threading it through to the heart. Patients generally receive anticoagulants to dissolve the clot, along with balloon angioplasty. Because of the anticoagulants, it’s important to control patient bleeding. In a radial approach STEMI, inserting the catheter into the radial artery via the wrist tends to cause less bleeding than groin insertion, an important benefit of the novel procedure. Additionally, the procedure offers patients the ability to begin earlier ambulation and return to daily living activities.

Robert Schiller, 72, recently had this novel procedure following a heart attack, yet the mark from the catheter appears like a “very tiny pimple,” he told WOFL-Channel 35, the Fox affiliate for Orlando.

Schiller compared the spectacular results of his radial angioplasty to the conventional ones his co-worker received. “She was out two months and I was only out two weeks,” he said. “Just a little bit each day, I’m getting better and better.”

Research consistently proves that the transradial angioplasty significantly reduces complications by 70 percent compared to the regular method, Madan said.

“This innovative approach for STEMI is a safer alternative to traditional treatment and improves patient outcomes,” he added. “Unfortunately in the U.S., it's slow to acquire and only 4 percent of people in this country can do procedures through radial approach. Cost wise, it's exactly the same, but requires a shorter length of hospital stay.”

Madan is part of the Cardiac Clinic group, established by Sunil Kakkar, MD, in 1981. The seven-physician group offers innovative and specialized cardiovascular procedures; Madan is teaching several other cardiologists this new technique.

“We at the institute want to make this approach available to the community,” he said. “It’s new but has safety and effectiveness advantages over the conventional femoral approach. We did an internal control study and when asked, patients who had both femoral and radial catheterizations overwhelmingly chose ‘the one done from wrist over groin anytime, if needed again.’"

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