[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-451057-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-451057-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","reply-distal-radial-access-in-stemi-where-feasibility-meets-clinical-reality","Reply - Distal Radial Access in STEMI - Where Feasibility Meets Clinical Reality","","Reply letter addressing comments on the DRAMI trial comparing distal radial access (DRA) and transradial access (TRA) for successful puncture in ST-segment elevation myocardial infarction. Additional analyses across early, mid, and late enrollment periods evaluate puncture success, time, procedural duration, fluoroscopy, and contrast use. Results show gradual improvements in DRA puncture outcomes without statistical significance, while later-period procedure and contrast parameters suggest complexity. Concludes with recommendations for ultrasound-guided protocols, miniaturized hydrophilic devices, and further long-term radial artery patency assessment.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/reply-distal-radial-access-in-stemi-where-feasibility-meets-clinical-reality/451057/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/reply-distal-radial-access-in-stemi-where-feasibility-meets-clinical-reality/451057.png","ImageObject",300,407,{"name":42,"@type":43},"Chumphorn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the DRAMI trial’s primary objective mentioned in the reply?","Question",{"text":63,"@type":64},"To explore the feasibility of distal radial access (DRA) in an emergency setting, especially for patients with ST-segment elevation myocardial infarction.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How do puncture success and puncture within 5 minutes change across early, mid, and late periods for DRA?",{"text":68,"@type":64},"They gradually increase in the DRA group, but the reply notes these improvements do not reach statistical significance.",{"name":70,"@type":61,"acceptedAnswer":71},"Why does the reply suggest longer procedure time and higher contrast use in the late DRA period?",{"text":72,"@type":64},"It suggests the differences likely reflect procedural complexity rather than limitations specific to the access approach.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},451057,1791065104,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":97,"preview_page_count":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","J A C C : A D V A N C E S V O L . 5 , N O . 1 , 2 0 2 6  \n© 2 0 2 6 T H E A U T H O R S . P U B L I S H E D BY E L S E V I E R O N B E H A L F O F T H E A M E R I C A N  \nC O L L E G E O F C A R D I O L O GY F O U N D A T I O N . T H I S I S A N O P E N A C C E S S A R T I C L E U N D E RT H E C C B Y-N C-N D L I C E N S E ( [h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y-n c-n d / 4 . 0 /](h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y-n c-n d / 4 . 0 /) ) .  \nREPLY: Distal Radial Access in STEMI  \nWhere Feasibility Meets Clinical Reality  \nWe sincerely appreciate the insightful comments and perspectives provided by Dr Skalidis and colleagues regarding our DRAMI (Comparison of distal radial access and transradial access for the successful puncture in patients with ST-segment elevation myocardial infarction) trial.1 As emphasized, the primary objective of the DRAMI trial was to explore the feasibility of distal radial access (DRA) in emergency setting, particularly in patients with STsegment elevation myocardial infarction.  \nIn response to the comments, we conducted additional analyses based on the enrollment sequence, classifying the study population into early,  \n\n| TABLE 1 Procedural Characteristics Between DRA and TRA According to Enrollment Period |  |  |  |\n| --- | --- | --- | --- |\n|  | DRA | TRA | P Value |\n| Puncture success |  |  |  |\n| Early period | 54 (90) | 57 (98 .3) | 0.060 |\n| Mid period | 57 (95) | 55 (94 .8) | 0.966 |\n| Late period | 55 (98 .2) | 59 (95 .2) | 0.360 |\n| P value for trend | 0.155 | 0.571 |  |\n| Puncture within 5 min |  |  |  |\n| Early period | 54 (90) | 56 (96 . 6) | 0.157 |\n| Mid period | 55 (91 .7) | 56 (96 . 6) | 0.261 |\n| Late period | 54 (96 .4) | 58 (93 .5) | 0.477 |\n| P value for trend | 0.393 | 0.654 |  |\n| Puncture time, min |  |  |  |\n| Early period | 2.2 ± 2.7 | 1.6 ± 2.4 | 0.213 |\n| Mid period | 1.9 ± 2.2 | 1.4 ± 1.4 | 0.136 |\n| Late period | 1.5 ± 1.8 | 1.9 ± 2.9 | 0.298 |\n| P value for trend | 0.189 | 0.420 |  |\n| Procedure time, min |  |  |  |\n| Early period | 46.3 ± 17.3 | 43.6 ± 19.8 | 0.434 |\n| Mid period | 41.0 ± 24.3 | 36.3 ± 14.3 | 0.200 |\n| Late period | 49.6 ± 27.9 | 43.0 ± 20.6 | 0.139 |\n| P value for trend | 0.138 | 0.063 |  |\n| Fluoroscopic time, min |  |  |  |\n| Early period | 12.7 ± 7.0 | 12.3 ± 7.9 | 0.756 |\n| Mid period | 13.7 ± 11.2 | 12.2 ± 6.4 | 0.376 |\n| Late period | 16.9 ± 11.5 | 13.9 ± 8.2 | 0.158 |\n| P value for trend | 0.100 | 0.413 |  |\n| Contrast volume, mL |  |  |  |\n| Early period | 154.1 ± 42.8 | 153.5 ± 58.0 | 0.948 |\n| Mid period | 146.1 ± 46.3 | 134.2 ± 43.8 | 0.153 |\n| Late period | 181.5 ± 59.2 | 154.8 ± 49.0 | 0.009 |\n| P value for trend | \u003C0.001 | 0.049 |  |\n| Values are presented as number (%) or mean ± SD.\u003Cbr>DRA = distal radial access; TRA = transradial access. |  |  |  |\n\nmid, and late periods. Procedural characteristics were compared between DRA and transradial access within each period, as well as across the 3 periods for each access type (Table 1) .  \nThe rates of puncture success and puncture within 5 minutes gradually increased in the DRA group, although without statistical significance. Puncture time also progressively decreased over the study periods, suggesting that a learning curve effect may have contributed to the observed noninferiority gap. Conversely, the longer procedure time, fluoroscopic time, and higher contrast use in the late DRA period likely reflect procedural complexity rather than access-specific limitations.  \nRegarding anatomical variability and smaller vessel diameter, future investigations should assess whether standardized ultrasound-guided DRA protocols incorporating miniaturized, hydrophilic devices can further improve procedural efficiency and safety.  \nFinally, long-term preservation of the radial artery remains a key consideration. Further studies using postprocedural intravascular imaging and serial ultrasonographic follow-up could help elucidate ","cbCaidVTSy7SgL31","https://ap.wps.com/l/cbCaidVTSy7SgL31","pdf",229172,"English","# Reply: Distal Radial Access in STEMI\n## DRAMI trial objective and response to comments\n## Additional analysis by enrollment period (Table 1)\n## Interpretation of procedural and time outcomes\n## Future directions for protocols and long-term outcomes","[{\"question\":\"What is the DRAMI trial’s primary objective mentioned in the reply?\",\"answer\":\"To explore the feasibility of distal radial access (DRA) in an emergency setting, especially for patients with ST-segment elevation myocardial infarction.\"},{\"question\":\"How do puncture success and puncture within 5 minutes change across early, mid, and late periods for DRA?\",\"answer\":\"They gradually increase in the DRA group, but the reply notes these improvements do not reach statistical significance.\"},{\"question\":\"Why does the reply suggest longer procedure time and higher contrast use in the late DRA period?\",\"answer\":\"It suggests the differences likely reflect procedural complexity rather than limitations specific to the access approach.\"}]","Reply - Distal Radial Access in STEMI - Where Feasibility Meets Clinical Reality | PDF",1790734298]