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Background The COVID-19 pandemic negatively affected access to health-care system and timeline of treatment. The fear of contamination might potentially forbear from accessing the emergency system.mFurthermore, pandemic-specific protocols require additional time to prepare medical stuff and catheterization laboratory before procedure. Thus, patients with ST-segment elevation myocardial infarction (STEMI) might be exposed to a longer delay for revascularization and higher risk of mortality. Purpose The aim of this study was to evaluate treatment delay and clinical outcomes in COVID-19 positive and negative patients with STEMI treated with percutaneous coronary intervention (PCI) during on- and off hours. Methods All consecutive patients with STEMI treated with PCI and stent implantation between 1st March 2020 and 31st December 2020 were enrolled into analysis. To overcome potential bias related to the non-randomized design a propensity score match (PSM) was used to compare COVID-19 positive and negative patients for both working frames hours. The study group consisted of 877 matched pairs treated during regular hours (everyday 7:00AM-16:59PM) and 418 matched pairs with PCI performed during off-hours (everyday 17:00PM and 06:59AM) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry). Results After PSM there were no differences between COVID-19 positive and negative patients in baseline characteristics during both on- and off-hours. However, patients diagnosed with COVID-19 were admitted with cardiac arrest more frequently as compared to COVID-19 negative patients during regular working hours (180 (20.5%) vs. 64 (7.30%); p=0.001). There were no differences in radiation doses and total amount of contrast between both groups. Similarly, no differences in rate of periprocedural complications were observed despite of time of intervention, including stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. Furthermore, there were no differences in periprocedural mortality between both groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%),p=0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%),p=0.5). However, COVID-19 positive patients were exposed to longer time from first medical contact to angiography during both on-hours (133.76 (±137.10) vs. 117.14 (±135.83) [min]; p=0.001) and off-hours (148.08 (±201.56) vs. 112.19 (±138.72) [min]; p=0.003). Time from pain to first medical contact remained similar during both working frame hours (On-hours and off-hours, respectively: p=0.7 and p=0.9). Conclusions Patients diagnosed with COVID-19 might experience a longer time from first medical contact to revascularization. There was no impact of COVID-19 diagnosis on rate of periprocedural mortality or periprocedural complication, irrespective of time of intervention. System-level changes might be crucial to improve health-care during COVID-19 pandemic. Funding Acknowledgement Type of funding sources: None.

Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. 75% vs. 50–75% vs. 25–50% vs. Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

Introduction The use of the radial approach (RA) for percutaneous coronary intervention (PCI) has gradually increased. Several studies demonstrated that radial artery is associated with significant reduction in major adverse cardiac events for both coronary angiography and PCI in acute coronary syndrome (ACS). However, it is still unclear if the side of RA has influence on clinical outcomes in an all-comer population in ACS settings. Purpose We sought to evaluate safety, feasibility, and clinical outcomes of right radial approach (RRA) compared to left radial approach (LRA) during PCI in “real-world” patients with ACS. Methods A total of 234,087 consecutive patients with ACS treated with PCI and stent implantation via radial approach between 2014 and 2017 in 151 invasive cardiology centers on the Polish territory. Data was based on the ORPKI Polish National Registry. Patients treated with RRA and LRA were compared using a propensity score analysis to avoid possible selection bias. The analysis was done in an “as-treated” manner. Results Procedure was conducted using RRA and LRA in 180,378 (77.1%) and 53,709 (22.9%) patients, respectively. After propensity score matching higher total amount of contrast (174.28 (±75.56) vs. 166.95 (±70.57) [ml]; P=0.001) and radiation doses were reported in PCI with left radial artery utilization (1210.21 (±1003.53) vs. 1054.07 (±1024.17) [mGy]; p=0.001). No differences were observed between RRA and LRA in rate of periprocedural adverse events such as myocardial infarction (0.08% vs. 0.08%; p=0.9) stroke (0.02% vs. 0.01%; p=0.1), no-reflow phenomenon (0.64%vs. 0.56%; p=0.1) and death (0.25% vs. 0.24%; p=0.7). A trend towards a lower rate of access-site-related bleeding during PCI was observed in RRA group (0.08% vs. 0.05%; p=0.066). Coronary artery perforation (0.21% vs. 0.16%; p=0.05) and cardiac arrest (0.56% vs 0.42%; p=0.01) were reported more often during PCI conducted with LRA. Conclusions Both radial approaches seems to be equally effective in the setting of PCI in ACS. However, utilization of left radial artery was associated with trend toward increased risk of access-site bleeding and higher rate of periprocedural complications as compared to RRA. Higher amount of contrast and radiation doses used in LRA procedures might be equivalent of generally lower experience with this access site. Acknowledgement/Funding None