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Published on: June 12, 2021
Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience
Oriol Rodriguez-Leor1, Eduard Fernandez-Nofrerias, Xavier Carrillo
1Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. oriolrodriguez@gmail.com
Insights
Transradial approach (TRA) for percutaneous coronary intervention (PCI) in cardiogenic shock (CS) is feasible and safe. TRA is associated with significantly lower mortality compared to transfemoral approach (TFA).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial approach (TRA) is increasingly used for percutaneous coronary intervention (PCI).
- TRA demonstrates lower mortality than transfemoral approach (TFA) in acute coronary syndrome.
- Previous studies have excluded patients with cardiogenic shock (CS) from comparative analyses.
Purpose of the Study:
- To evaluate the safety and efficacy of TRA versus TFA in patients with CS undergoing emergent PCI.
- To identify factors influencing the choice of vascular access in CS patients.
Main Methods:
- Prospective, observational registry study of 1,400 emergent revascularization procedures.
- Analysis focused on 122 patients with CS, comparing outcomes between TRA and TFA.
- Multivariate analysis was used to identify predictors of mortality.
Main Results:
- Of 122 CS patients, 80 (65.6%) underwent PCI via TRA and 42 (34.3%) via TFA.
- TRA was associated with significantly lower in-hospital mortality (32.5% vs. 64.3%, P = .001).
- TRA also showed fewer serious access site complications (2.5% vs. 11.9%, P = .03) and major adverse cardiac events (43.8% vs. 73.8%, P = .001).
Conclusions:
- Transradial approach for PCI is feasible and safe in a majority of patients with cardiogenic shock.
- Absence of radial pulse was the primary limitation for TRA utilization.
- Multivariate analysis confirmed TRA as an independent predictor of reduced mortality in CS patients.
Background:
Use of the transradial approach (TRA) in percutaneous coronary intervention (PCI) has increased in recent years. TRA has a lower mortality rate than the transfemoral approach (TFA) in patients with acute coronary syndrome. Comparative studies have systematically excluded patients with cardiogenic shock (CS).
Methods:
We performed a prospective, observational registry study of consecutive patients undergoing emergent revascularization between February 2007 and January 2012. An analysis of the clinical evolution of patients with CS during hospitalization was performed.
Results:
Of 1,400 emergency procedures, 122 had CS, of which 80 underwent PCI by TRA (65.6%) and 42 underwent PCI by TFA (34.3%). The main reason for choosing TFA was the absence of radial pulse (54.9%). Mortality (64.3% vs 32.5%, P = .001), serious access site complications (11.9% vs 2.5%, P = .03), access site complications requiring blood transfusion (7.1% vs 0%, P = .04), and major adverse cardiac events (death, infarction, stroke, serious bleeding, and postanoxic encephalopathy) (73.8% vs 43.8%, P = .001) were greater in patients treated by TFA. In the multivariate analysis, TRA was a predictor of mortality (odds ratio [OR] 0.39 [0.15-0.97]); other predictive factors were age ≥75 years (3.47 [1.35-8.92]), previous treatment with diuretics (3.67 [1.21-11.12]), and success of the procedure (0.07 [0.02-0.24]).
Conclusions:
Transradial approach for PCI is possible and safe in up to two-thirds of patients with CS. Absence of radial pulse was the main factor preventing use of TRA. In multivariate analysis, TRA was associated with a lower risk of mortality.
