Impact of Access Site in Percutaneous Coronary Intervention for Patients Complicated With Cardiogenic Shock: A Systematic Review and Meta‐Analysis of 33,311 Individuals

Vascular access site selection remains critical in patients with cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI), with transradial access (TRA) increasingly favored for its potential safety benefits over transfemoral access (TFA). A systematic search of PubMed, Cochrane Library, and Science Direct was conducted from inception to March 2025. Meta-analysis was performed using RevMan v5.3. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Publication bias was assessed with funnel plots, Egger's test, and Begg's test using R software (version 4.5.0). Thirteen studies comprising 33,311 patients were included. TRA illustrated significantly reduced in-hospital mortality (OR: 0.45; 95% CI: 0.30-0.67; p < 0.0001), 30-day mortality (OR: 0.57; 95% CI: 0.44-0.75; p < 0.0001), and 1-year mortality (OR: 0.49; 95% CI: 0.40-0.60; p < 0.00001) compared to TFA. Major bleeding was significantly lower in the TRA group (OR: 0.53; 95% CI: 0.32-0.88; p = 0.01), as was the incidence of MACE (OR: 0.41; 95% CI: 0.25-0.68; p = 0.0004). No significant differences were observed in procedural success (OR: 0.73; 95% CI: 0.39-1.36; p = 0.32), contrast volume (MD: 6.95; 95% CI: -8.62 to 22.53; p = 0.38), or fluoroscopy time (MD: 0.11; 95% CI: -1.15 to 1.38; p = 0.86). TRA is associated with improved survival and safety outcomes in CS patients undergoing PCI, without compromising procedural efficiency. These findings support TRA as the preferred access strategy in experienced centers, though future long-term studies are needed to validate these results.