Key result
Radial approach linked to ~49% lower periprocedural mortality vs femoral in STEMI with cardiogenic shock.
Why the study?
Most studies demonstrating the benefit of radial over femoral approach in STEMI excluded patients with cardiogenic shock, leaving outcomes in this subgroup unclear.
Does the radial approach reduce periprocedural mortality compared to the femoral approach in patients with STEMI complicated by cardiogenic shock?
Observational (n=1,890)
Yes
Does the radial approach reduce periprocedural mortality compared to the femoral approach in patients with STEMI complicated by cardiogenic shock?
Absolute Event Rate: 9.4% vs 18.6%
p-value: p=0.001
In patients with STEMI complicated by cardiogenic shock, utilizing a radial approach for PCI is associated with significantly lower periprocedural mortality and cardiac arrest compared to a femoral approach.
Radial access may warrant consideration in STEMI shock; leaves open whether it causally improves outcomes versus femoral access.
INTRODUCTION: The beneficial outcome of the radial (RA) over femoral approach (FA) in ST-segment elevation myocardial infarction (STEMI) has been widely demonstrated. However, most of the studies excluded patients with STEMI and cardiogenic shock (CS). OBJECTIVES: We sought to evaluate periprocedural outcomes of percutaneous coronary intervention (PCI) with RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI). PATIENTS AND METHODS: A total of 3,565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data was collected prospectively between 2014 and 2018 from 151 tertiary primary-PCI centers in Poland. To avoid possible selection bias, a propensity score matching (PSM) was used to create 945 matched pairs treated via RA or FA. RESULTS: No differences were reported in baseline characteristics, clinical presentation and delays in treatment between RA and FA after the PSM. Similar radiation doses and the total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, RA was associated with reduced periprocedural mortality (9.4% (89) vs. 18.6% (176); P=0.001) and lower incidence of cardiac arrest (9.7% (92) vs. 16.1% (152); P=0.001). In multivariable analysis, FA was the strongest independent predictor for increased periprocedural mortality (OR 2.087, 95% CI 1.629-2.674; P=0.001). CONCLUSIONS: The radial approach was associated with lower periprocedural mortality compared with FA in patients with STEMI complicated by CS. RA seems to be a valuable option in technically feasible situations.
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Tokarek et al. (2021) conducted an observational in ST-segment elevation myocardial infarction complicated by cardiogenic shock (n=1,890). Radial approach vs. Femoral approach was evaluated on Periprocedural mortality (p=0.001). The radial approach was associated with significantly lower periprocedural mortality (9.4% vs 18.6%) compared with the femoral approach in patients with STEMI complicated by cardiogenic shock.
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