What question did this study set out to answer?

To assess the effectiveness of transradial access compared to femoral access in patients with STEMI complicated by cardiogenic shock during primary PCI.

May 16, 2026Open Access

Reconsidering Radial Strategy in Cardiogenic Shock

NKNamkyun KimInterventional / Structural Cardiology YKYong Wook KimON Semiconductor (United States)

Key Points

To assess the effectiveness of transradial access compared to femoral access in patients with STEMI complicated by cardiogenic shock during primary PCI.
Integrated a nationwide multicenter registry with over 65,000 patients
Conducted a large-scale meta-analysis
Performed sensitivity analyses using propensity score matching and inverse probability treatment weighting.
Transradial access associated with a 38% relative reduction in in-hospital mortality (absolute risk reduction 11.0%; number needed to treat 9)
Significant decrease in major adverse cardiovascular events observed with transradial access
Adjusted hazard ratio for major bleeding with transradial access at 0.72 (95% CI, 0.35-1.49; p=0.381)

Abstract

1/3 https://e-kcj.orgTransradial access (TRA) is a Class I recommendation for percutaneous coronary intervention (PCI) in acute coronary syndromes in both the European and American guidelines. 1)2)This recommendation is largely based on the Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) trial, which demonstrated that TRA significantly reduced net adverse clinical events, major bleeding, and all-cause mortality compared with transfemoral access (TFA). 3)However, in ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS), hemodynamic instability and the anticipated need for large-bore femoral access for mechanical circulatory support (MCS) often lead operators to choose femoral access, despite current guidelines favoring the radial approach.Furthermore, the Safety and Efficacy of Femoral Access vs Radial Access in ST-Elevation Myocardial Infarction (SAFARI-STEMI) trial found no significant difference in 30-day survival between radial and femoral access in STEMI patients undergoing primary PCI. 4)Thus, dedicated evidence on access-site strategy in the STEMI-CS population is needed.In this issue of the Korean Circulation Journal, Zhang et al. 5) present a comprehensive evaluation of arterial access strategy in patients undergoing primary PCI for STEMI complicated by CS.By integrating a nationwide multicenter registry with a large-scale meta-analysis including more than 65,000 patients, the investigators demonstrate that TRA is associated with a 38% relative reduction in in-hospital mortality (absolute risk reduction, 11.0%; number needed to treat, 9) and a significant decrease in major adverse cardiovascular events (MACE).These findings were consistent across multiple sensitivity analyses using propensity score matching and inverse probability treatment weighting.In the registry analysis, major bleeding was numerically lower with TRA but did not reach statistical significance (adjusted hazard ratio, 0.72; 95% confidence interval CI, 0.35-1.49;p=0.381), whereas the pooled meta-analysis confirmed a significant reduction in major bleeding favoring TRA (odds ratio, 0.58; 95% CI, 0.48-0.71).These findings are consistent with prior large-scale data.In an analysis of 35,944 patients with acute myocardial infarction and CS from the National Cardiovascular Data Registry

KI fragen

Bookmark

View Full Paper