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Background. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization. [ABSTRACT FROM AUTHOR]

Background: Systematic screening for coronary artery disease (CAD) and routine percutaneous coronary intervention (PCI) of significant lesions before for transcatheter aortic valve implantation (TAVI) have been reconsidered recently because of no evidence of benefit.1,2 We wanted to investigate important clinical factors that could predict the importance of coronary artery disease in patients scheduled for TAVI. Patients and Methods: We retrospectively analyzed all patients with confirmed CAD who underwent TAVI in our center from April 2012 to May 2023. Data on CAD diagnosis and management were compared between patients with different CAD treatment strategies, in regard to complications and composite event rate of death and myocardial infarction during follow-up. Results: Among 349 patients (median age 80 years, 52% males, median AVA 0.7 cm2 ), 124 (36%) had confirmed CAD. Routine invasive coronary angiography during TAVI work-up was performed in 328 (94%) of patients. Patients with CAD had median age of 79, with 88/124 (71%) of males. History of PCI or CABG was noted in 61 (49%) and 46 (37%) of patients, respectively. Significant CAD deserving clinical attention was found in 80 (65%) patients, out of which 48 (60%) patients underwent PCI before TAVI. There were no differences in TAVI complications in regard to CAD management. Composite event rate of death and myocardial infarction during follow-up did not differ significantly between patients treated conservatively (28%) and patients who received PCI (21%) (OR 1.58, 95% CI 0.66-3.64). Significant univariate predictors of composite endpoints were male gender, peripheral artery disease (PAD), history of CABG, and reduced LVEF below 50%. Only PAD remained significant in a multivariate Cox regression analysis (OR 3.02, 95% CI 1.16-7.84). Conclusion: Routine PCI before TAVI did not impact clinical outcomes, so CAD could be considered bystander disease in most TAVI candidates. However, our data showed that CAD with history of CABG, reduced EF, and PAD, probably deserves a more scrutinized approach for better long-term outcomes after TAVI, and therefore it should not be considered as bystander in TAVI patients with any of these characteristics. [ABSTRACT FROM AUTHOR]

Introduction: In stable patients planned for transcatheter aortic valve implantation (TAVI), systematic screening for coronary artery disease (CAD) and routine percutaneous coronary intervention (PCI) of angiographically significant lesions before TAVI has been considered a standard of care.1 However, recent analyses showed no evidence of benefit after coronary revascularization before TAVI in stable patients. Patients and Methods: We retrospectively analyzed all patients who underwent TAVI in our center from 2012 to 2022. Data on coronary artery disease (CAD) diagnosis and management were compared to other relevant clinical characteristics, in regard to composite event rate of death and myocardial infarction during follow-up. Results: Among 293 patients (median age 80 years, 53% males, median AVA 0.7 cm2, with 62% of balloon expandable valves), 105 (36%) had confirmed CAD. History of previous revascularization (PCI or surgical) was noted in 84 (29%) of patients. Routine coronary angiography before TAVI was performed in 280 (96%) patients, with significant CAD deserving clinical attention found in 63 (23%) patients. Composite event rate of death and myocardial infarction during follow-up was not significantly higher among patients with confirmed CAD (OR 0.93, 95% CI 0.54-1.58), in contrast to peripheral artery disease (OR 3.25, 95% CI 1.91-5.54). Among 63 patients with significant CAD, 41 (65%) patients received PCI before TAVI, and their composite event rate did not differ from the remaining 35% of patients treated conservatively (OR 0.86, 95% CI 0.27-2.80). Conclusion: Stable CAD showed no impact on survival or myocardial infarction after TAVI, as well as routine PCI before TAVI in a subgroup of patients with significant CAD requiring clinical attention. Therefore, in a cohort of patients with similar characteristics, routine invasive coronary angiography during diagnostic work-up before TAVI could be redundant because invasive CAD management did not impact clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Highly calcified coronary lesions represent up to 30% of all coronary stenoses, and bring greater risk of complications and recurrent events. Non-compliant, cutting/scoring and super-high pressure balloons, together with debulking devices (rotablation and intravascular lithotripsy) are essential in calcium management. Patients and Methods: We aimed to investigate changes in patterns of calcium management in a tertiary institution cath-lab from 2018 to 2022. We compared yearly penetration of calcium debulking techniques in one center from 2018 to 2022 among all percutaneous coronary intervention (PCI) in patients with chronic and acute coronary syndromes. Results: Among all patients treated in 2018 and 2019, rotablation was used in 1.7% and 1.5% of all PCI cases, whereas super-high pressure balloons were used in 1.3% and 1.1% of cases for debulking. Noncompliant balloons were used for lesion preparation in 18% of all PCI. In 2021 and 2022, rotablation was used for debulking in only 0.4% of cases, whereas super-high pressure balloons were used in 1.2% of cases, often in combination with rotablation. Also, in 2021 and 2022 intravascular lithotripsy (IVL) was used in 1.4% of all PCI cases for debulking, and non-compliant balloons were used for lesion preparation in 32% of cases. Among all PCI in 2021 and 2022, there was 1 case of failed stent delivery in a tortuous calcified vessel, and 1 case of inadequate stent expansion after IVL that was successfully expanded with a super-high pressure balloon. Conclusion: In cases of highly calcified coronary lesions, IVL has been becoming a standard in crossable lesions, whereas rotablation has been used occasionally - almost exclusively in non-crossable lesions in combination with super-high pressure balloons after successful crossing. Also, routine use of non-compliant ballons for lesion preparation has increased markedly, whereas scoring balloons were not used routinely in calcified lesions. [ABSTRACT FROM AUTHOR]

Background: Dual antiplatelet therapy (DAPT) is a cornerstone of the treatment of acute coronary syndromes. In Rapid Early Action for Coronary Treatment 5 (ISAR-REACT 5) trial, prasugrel was superior to ticagrelor regarding the primary outcome, a composite of all-cause death, myocardial infarction (MI), or stroke, at 12 months. This superiority was primarily driven by a reduction in the number of MIs in the prasugrel group. Limited data are available concerning differences in clinical outcomes for real-life patients treated with ticagrelor versus prasugrel after percutaneous coronary intervention (PCI). One observational study indicated that prasugrel was safer and more effective than ticagrelor in patients with non-ST-elevation myocardial infarction (NSTEMI), with a reduction of reinfarction and major bleeding events at 12-month follow-up¹. Our objective was to determine and compare the efficacy and safety of ticagrelor and prasugrel in a real-world population in our center. Patients and Methods: This was an observational study conducted in Dubrava University Hospital. In total, 1380 patients (1176 ticagrelor, 204 prasugrel) who were hospitalized for acute MI from January 2017 to January 2020. There were 837 patients with acute myocardial infarction with ST elevation (STEMI) in ticagrelor group and 62 patients in prasugrel group. There were 329 patients with NSTEMI in ticagreolor group and 140 patients in prasugrel group. SYNTAX score was significantly higher in prasugrel group (13 vs 11). Median age of patients in prasugrel group was 64, and 62 in the ticagrelor group. Results: After 12 months of follow up, 5.8% patients in the ticagrelor experienced major adverse cardiac event (MACE) (reinfarction, death, stroke or bleeding) vs 1.5% of patients in the prasugrel group irrespective of MI type (STEMI or NSTEMI) (p=0.003). Conclusions: Comparison of these drugs suggested that prasugrel is safer and more efficacious than ticagrelor in combination with aspirin after both STEMI and NSTEMI. The nonrandomized design of the present research means further studies are required to support these findings. [ABSTRACT FROM AUTHOR]

Introduction: Findings from clinical trials cannot be generalized to population at large due to the stringent eligibility criteria. Real-world data (RWD) are data relating to patient health status and/or the delivery of health care routinely collected from a variety of sources. RWD complement clinical trials by generalizing the findings from clinical trial to general population. Furthermore, RWD can provide information on other areas, such as natural history and course of disease, effectiveness studies, outcome studies, and safety surveillance¹. Methods: In Dubrava University Hospital, RWD are a part of our every -day practice. Currently there are real world data concerning acute myocardial infarction, transcatheter aortic valve implantation, oral anticoagulation therapy in atrial fibrillation and pulmonary embolism, efficacy, and safety of sodium- glucose co-transporter-2 inhibitors (SLGT2i) in patients with heart failure. We collect RWD from Electronic health records (EHRs). After the enrolment, patients are followed up by accessing data from hospital information system and by telephone visits. Telephone visits are performed for all patients every 6 months to collect information on endpoints. Conclusion: Real-world data encompass a wide range of research methodologies and data sources and can be broadly categorized as non-interventional studies, patient registries, claims database studies, patient surveys and electronic health record studies. Studies that use RWD include a patient population that is far more representative of unselected patient populations than those of randomized clinical trials (RCT) but they do not provide a robust basis for comparing treatment strategies RWD cannot substitute RCT, they can complement the findings from RCTs by providing valuable information on treatment practices and patient characteristics among unselected patients. RWD from our center have been recognized in Croatian and global scientific community. It takes much effort to conduct such real-world data bases, it can be time consuming in everyday practice, but the results are what motivate us and drive us forward. [ABSTRACT FROM AUTHOR]

Case report: 64-years-old female was admitted because of subacute myocardial infarction (MI) of inferoposterior wall. Upon admission she was pale, hypotensive, prostrated with loud systolic heart murmur. Due to characteristics of heart murmur, mechanical complication was suspected and echocardiogram showed large (28mm) mid inferoseptal ventricular rupture (VSR). Because of cardiogenic shock with elevated lactates, intraaortic balloon pump (IABP) was inserted, coronary angiography was performed and occluded mid part of right coronary artery was found. With mechanical circulatory support (MCS) by IABP patient was stable with little dose of vasopressors. Cardiac surgeons were consulted and they suggested to postpone the operation. Third day after admission patient deteriorated so we decide to upgrade MCS and switched IABP to Impella CP3.5 with great circulatory improvement. Patient needed no inotropes or vasopressors to maintain mean arterial blood pressure, serum lactate was within normal range and she had no clinical and radiographic signs of pulmonary congestion. Tenth day by admission, surgery was performed. VSR was fixed by huge patch. After surgery, she was getting better but unfortunately died of septic, gram negative, shock. Discussion: Current guidelines recommends MCS, dominantly IABP in mechanical complications of acute MI. There are no recommendations for Impella CP usage. Ventricular septal defect is considered as relative contraindication for Impella insertion due to possibility of left-right shunt reversal1,2. With careful and precise placement of Impella in left ventricle (LV) and watchful hemodynamic monitoring it can be avoided. We suggest Impella implantation in VSR if the right ventricular function is normal as Impella reduces afterload, pulmonary capillary pressure, unloads LV and reduces wall stress of both ventricles while maintain cardiac output. Possible, but real, negative side of it, would be reversal of shunt to right/left and suction of necrotic myocardial tissue with peripheral embolization. [ABSTRACT FROM AUTHOR]

Objective: Limited data exists about health-related risk behavior among myocardial infarction (MI) survivors. Healthy lifestyle through physical activity, balanced diet and stress management remains the key recommendation in secondary prevention of cardiovascular events. However, this is challenging process that requires many lifestyle changes supported by organized professional help in the community, to encourage participants in the attempt to improve their health. In this study the relationship between COVID-19 vaccination status and dietary habits, among patients after myocardial infarction, has been evaluated. Positive correlation between vaccine hesitancy and poor diet could be explained by the lack of trust in science, lower level of education and lower health literacy¹. Patients and Methods: From January 2017 to January 2020, data from 1441 patients hospitalized for acute coronary syndrome in Dubrava University Hospital were reviewed. The median age of participants was 64 years, among them there were 409 females, and 974 males. The participants were divided into groups according to their COVID-19 vaccination status and dietary habits, based on diet questionnaire survey. Results: Patients who were not vaccinated less frequently reported daily consumption of fruit, fish, salad, and vegetables, with predominant consumption of pasta, lard, dried meats, white bread and alcohol (p<0.001). Conclusion: In our research, COVID-19 vaccination status in patients after myocardial infarction was associated with better dietary habits. This might imply that vaccinated patients show higher level of health literacy. Future research is necessary to establish which healthcare interventions are required in order to manage and maintain the full potential of health lifestyle improvement in those patients. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is considered one of the main reversible risk factors for coronary artery disease development. On the contrary, earlier research demonstrated that higher body mass index (BMI) might have a beneficial effect in some patients after acute myocardial infarction - a phenomenon called the “obesity paradox”1,2. The aim of this study is to determine a relation between the change in BMI and the long-term outcomes of patients treated for acute myocardial infarction. Patients and Methods: The patient registry for myocardial infarction in Dubrava University Hospital collects data on patients with ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) admitted to Department for Cardiovascular Medicine from January 2017. Patients without noted BMI value after 1-year of follow-up were excluded from this trial. A total of 1400 patients were divided into three groups with maintained, increased, and reduced BMI, the latter of which was further divided into groups with intentional and unintentional BMI reduction. The median follow-up time of all patients was 1298 days. We observed and compared the occurrence of major adverse cardiac events (MACE) among the examined groups of patients. Results: The group with reduced BMI had a significantly higher incidence of MACE (39.9%) in comparison to the groups with maintained (24.5%, p<0.001) and increased BMI (27.4%, p<0.001). There was no significant difference in the incidence of MACE between the groups with maintained and increased BMI (p=0.353). The patients who died during the follow-up had a significantly greater reduction of BMI than the survivors (1.50 vs 1.14, p<0.001), however, this is not applicable to other MACE. Patients with unintentional reduction of BMI had a much higher incidence of MACE than those with the intention to reduce BMI (69.1% vs 18.9%, p<0.001). Conclusion: The results of our study imply that reduction of BMI after undergoing treatment for STEMI or NSTEMI might represent a risk factor for the future development of MACE. Greater BMI reduction is connected to higher mortality, but not the occurrence of other MACE. In previously conducted research, we have not found the outcomes being evaluated based on patient’s intention to lose weight. We demonstrated that unintentional BMI reduction goes in pair with the highest incidence of MACE. [ABSTRACT FROM AUTHOR]

Introduction: Statin use in secondary prevention after acute coronary syndrome (ACS) is one of the most researched areas in cardiology¹. The aim of this study was to determine the association between adherence to statin therapy and major adverse cardiovascular events in patients after a myocardial infarction. Patients and Methods: The examined group consisted of 421 patients who were treated for ACS- percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) from 2019 to 2020 at the Dubrava University Hospital, Zagreb. We have collected basic demographic, clinical and laboratory data available in digital medical documentation. Adherence to the drug therapy was measured by Morisky Medical Adherence scale during telephone monitoring. It was primarily analyzed association between adherence to recommended statin therapy and occurrence of major adverse cardiovascular events (MACE), and secondarily the association of other demographic and clinical features with MACE. Results: Adherence to therapy after discharge was measured successfully in 371 (88%) patients. Most of them had moderately high adherence. Of the recommended drugs at discharge, the drug that respondents indicated as the one they most often forget to take, do not take regularly as prescribed was statin. Even 11% of patients did not take any dose of statin and 189 patients (51%) took the statin as recommended. A total of 93 (22%) patients experienced a composite MACE. Patients with low adherence to statin therapy had the highest proportion of MACE (26%) compared to the other two groups. Relative risk for experiencing MACE in patients who did not reach value of low-density lipoprotein cholesterol (LDL) <1,8 mmol/L at 12 months follow-up was 1.25 (25% higher relative risk, p=0.248) and was not statistically significant. On the other hand, the relative risk for experiencing MACE in patients who did not reach the target LDL-cholesterol value of less than 2.6 mmol/L after 12 months was 1.68 (68% higher relative risk, p=0.008) and was statistically significant. Conclusion: Our study aimed to show that regular statin therapy intake is as much important as achieving target LDL values in reducing MACE. [ABSTRACT FROM AUTHOR]

Introduction: Patients with diabetes have long been known to be at high risk for morbidity and mortality after an acute myocardial infarction (MI) in part, because of more extensive coronary artery disease, additional cardiovascular (CV) risk factors, and higher burden of comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are novel glucose-lowering treatments for type 2 diabetes with low risk for hypoglycemia that have been available in Croatia since March 2021. Trial evidence indicates that GLP-1 RAs may reduce the risk of CV events in patients with diabetes MI, but real-world data are limited. Therefore, we aimed to expand this observation to routine care settings¹. Methods and Results: Since March 2021, 74 diabetic patients that survived MI received GLP-1 RAs as a part of their diabetic care, and 22 of them had a follow-up period of 12 months. All the patients in our study used semaglutide as their GLP-1 RAs agent which represents the market penetration of this drug in Croatia. Median age of participants was 64 years in the group who received GLP-1 RAs, and 55 in the group who received other standard diabetic care. Median body mass index (BMI) in the group who received GLP-1 RAs was 32.98 kg/m², and in the other group 29.18 kg/m². After follow-up, BMI reduction was significantly higher in the GLP-1-RAs group (32.02 vs 28.8, p <0.01). In the GLP-1-RAs group, no patients experienced acute MI, stroke, new onset of atrial fibrillation. One patient died in GLP-1-RAs group from non-cardiac death. In non GLP-1 RAs group, 3.9 % patients experienced acute MI, 0.9% experienced stroke, 0.3% experienced pulmonary embolism and 1.5% experienced new onset of atrial fibrillation and 3.2% patients died of which 0.2% was non-cardiac death. Conclusion: We conclude that compared with the standard of diabetes care, the use of GLP-1 RAs by routinely cared survivors of an acute MI was associated with a lower risk of subsequent major CV adverse events as well as significantly reduction in BMI. The cardio-protective effects of GLP-1-RAs seem to go beyond glucose control, possibly involving weight loss, although the real mechanism is not clear. Further real-world studies are needed to confirm these statements. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) and acute myocardial infarction (MI) often coexist together whether it is MI in patients with earlier AF or AF as a complication of MI. Previously published work has shown results indicating worse quality of life in patients with both AF and MI, with some potential differences in long-term outcomes depending on time of fibrillation onset.1,2 We aimed to compare clinical outcomes of IM patients with prior and new onset AF at two tertiary centers. Patients and Methods: We evaluated 1662 patients discharged after acute MI at Dubrava University Hospital and „Merkur“ University Hospital from January 2017 to December 2021, followed up to present date. Among them, 28 patients who were discharged had AF prior to MI, whereas 42 patients had newly diagnosed AF. We compared the differences in baseline characteristics, all cause death as the primary outcome and all-combined MACE events as secondary outcome in follow up between patients without AF, prior AF and new onset AF. Results: Our results show that patients with AF diagnosed after MI were significantly older and were discharged with lower eGFR and left ventricular ejection fraction compared to the other groups (p<0.05). After comparing the groups in follow up, the new onset AF group had significantly lower survival time (HR 3.24 compared to no AF, HR 4.71 compared to prior AF, p<0.001). However, in multivariate analysis after adjustment for clinically relevant parameters, there was no significant difference in survival probability between the groups. There was no statistically significant difference in free-from MACE time between the three groups. Conclusion: Our data suggests potentially increased long-term mortality in those who develop AF in the acute setting of MI. Further research is necessary to evaluate the potential risks of new onset AF and to develop strategies for its prevention. [ABSTRACT FROM AUTHOR]

Aim To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. Methods Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or nearnormal left ventricular ejection fraction (≥50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. Results Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (≥80 pg/mL) at 24 hours (P = 0.001) and 7 days (P = 0.020) after STEMI and successful reperfusion. Patients who had BNP levels ≥80 pg/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P = 0.008). Conclusion BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission. [ABSTRACT FROM AUTHOR]

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Aim: To assess the efficacy of high sensitive C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatin kinase (CK) as long-term predictors of heart failure in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI) with successful and complete revascularization and to compare their predictive value with B-type natriuretic peptide predictive value. Patients and Methods: This prospective study evaluated 47 patients with acute STEMI who had normal left ventricular ejection fraction (LVEF) (50%) at admittance and underwent complete revascularization. Blood samples were collected from admission to the day 7. The primary endpoint was the reduction of LVEF <50% after 12 months. Results: Patients who reached primary endpoint had significantly higher mean values of cTnT after 24h (5.11 vs 2.82 µg/L; p=0.0101) and peak values of CK (3375.5 vs 1865 U/L, p=0.0084). Equally, the patients with cTnT after 24h Q4 when compared to the ones with Q1Q3 were 6 times more likely to develop LVEF <50% (OR 6.27, 95% CI 1.35-29.06, p=0.0200). Regarding hsCRP, there was no significant relation between hsCRP and development of primary end-point, neither when the values are dichotomized at a cut-off limit of ≥11 mg/l (p=0.5410) nor when they are split into quartiles (p=0.8482). Conclusion: cTnT and CK could serve as predictors of reduced LVEF in patients with acute STEMI who had normal systolic function at admission, single-vessel disease, and were successfully revascularized during the primary PCI. However, BNP showed to be a more powerful predictor in this low-risk population, even more powerful than the multimarker score we designed. [ABSTRACT FROM AUTHOR]

Aim: In the last few years University Hospital Center Sestre milosrdnice, Zagreb has become dedicated to the radial approach with nearby 90% of percutaneous coronary interventions (PCI) performed with either left or right radial access route. In time, left radial approach has become the first choice option for most of the patients (pts) with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to compare the efficacy and safety of left transradial access (L-TRA) with the right transradial (R-TRA) and transfemoral (TFA) access in the setting of primary (PCI) for acute (STEMI). Patients and Methods: This single-center, retrospective study included 767 consecutive acute STEMI patients, treated with primary PCI from January 2011 to May 2013, who were divided in three groups according to the arterial access site: L-TRA group (413 patients, 53.85%), R-TRA group (110 patients, 14.34%) and TFA group (244 patients, 31.81%). We collected data on the procedure success, procedure, door-to-balloon and fluoroscopy time and bleeding complications. Of all the patients, 43.5% of them were admitted directly through the emergency department and 56.5% of them were transported from other hospitals being the part of the Croatian pCi network. Results: Procedural success was similar among the three groups (L-TRA vs TFA 93.2% : 88.5%, p=0.495; and L-TRA vs R-TRA 93.2% : 90.1%, p=0.855). Additionally, all investigated procedural characteristics were similar among compared groups, including total procedure time (L-TRA vs TFA 71.9±18.4 : 73.3±21min, p=0.366; and L-TRA vs R-TRA 71.9±18.4 : 72.7±21.3min, p=0.966) and fluoroscopy time (L-TRA vs TFA 11.1±6.9 : 11.6±9.3min, p=0.461; and L- TRA vs R-TRA 11.1±6.9 : 12.8±8.2min, p=0.128). When considering the bleeding complications (change in the concentration of haemoglobin), there were no differences between the three groups (L-TRA vs TFA 10±10.1 : 11±10.8 g/L, p=0.308; and L-TRA vs R-TRA 10±10.1 : 10±11.8 g/L, p=0.254). Conclusion: In a PCI center committed to PCI, left transradial approach for acute STEMI patients undergoing primary PCI, is as equally effective and safe as transfemoral or right transradial approach. [ABSTRACT FROM AUTHOR]