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Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock
Toshiharu Fujii1, Naoki Masuda, Takeshi Ijichi
1Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Insights
Transradial intervention (TRI) is safe and effective for ST-elevation myocardial infarction (STEMI), even in patients with cardiogenic shock. This approach offers benefits over transfemoral intervention (TFI), including faster treatment times and fewer complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Transradial intervention (TRI) is increasingly used for ST-elevation myocardial infarction (STEMI) in high-volume centers.
- However, its application in STEMI patients experiencing cardiogenic shock remains underreported.
Purpose of the Study:
- To compare clinical outcomes of TRI versus transfemoral intervention (TFI) in primary percutaneous coronary intervention (PCI) for STEMI patients.
- To evaluate the safety and efficacy of TRI in STEMI patients with and without cardiogenic shock.
Main Methods:
- Retrospective study of 425 STEMI patients undergoing primary PCI.
- Patients categorized into four groups: TRI without shock (n=273), TRI with shock (n=38), TFI without shock (n=71), and TFI with shock (n=43).
Main Results:
- PCI success rates were comparable across all groups.
- TRI demonstrated shorter cath lab activation times and fewer access site complications compared to TFI in non-shock STEMI patients.
- In shock patients, TRI showed a trend towards shorter activation times and fewer complications, with similar 30-day mortality rates compared to TFI (28.9% vs. 25.6%).
Conclusions:
- Transradial intervention is a safe and feasible default approach for STEMI in high-volume centers.
- TRI can be effectively applied to STEMI patients in severe shock, yielding clinical outcomes comparable to TFI.
Objectives:
To compare clinical outcomes between transradial (TRI) and transfemoral intervention (TFI) in primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) with or without shock.
Background:
TRI for STEMI has benefits in TRI high volume centers. However, TRI has not been reported for STEMI with shock even in such centers.
Methods:
We retrospectively studied 425 STEMI patients who underwent primary PCI. Patients were divided into four groups according to approach site and presence of cardiogenic shock, including TRI without shock (TR group, n = 273), TRI with shock (TRS group, n = 38), TFI without shock (TF group, n = 71), and TFI with shock (TFS group, n = 43).
Results:
PCI success rates were similar among the four groups. The TR group was superior to the TF group in terms of shorter cath lab to first device activation time, and lower access site complications, and 30-day mortality rates (1.1% vs. 11.3%, P < 0.001). In shock patients, cardiopulmonary arrest was commonly observed in both the TRS and TFS groups (42.1% and 51.2%, respectively). The TRS group showed a trend toward a shorter door to first device activation time compared to the TFS group and lower access site complications; however, 30-day mortality rate was 28.9% in TRS and 25.6% in TFS group (P = 0.7).
Conclusions:
In TRI high volume center, TRI for STEMI was safe and feasible as a default approach. TRI could be applied to severe shock patients with similar clinical outcome to TFI.
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