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Arterial access site utilization in cardiogenic shock in the United Kingdom: is radial access feasible?
Mamas A Mamas1, Simon G Anderson1, Karim Ratib2
1Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
Insights
Transradial access (TRA) for percutaneous coronary intervention in cardiogenic shock (CS) patients is linked to lower mortality and fewer adverse events compared to transfemoral access (TFA). TRA is a viable alternative in experienced centers.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Cardiogenic shock (CS) is a major cause of mortality in acute myocardial infarction (AMI) patients.
- Transfemoral access (TFA) is often preferred for PCI in CS patients, despite the increasing adoption of transradial access (TRA).
- CS presents unique challenges, making it a difficult frontier for radial access procedures.
Purpose of the Study:
- To investigate the utilization and outcomes of TRA versus TFA in patients with CS undergoing PCI.
- To assess the safety and efficacy of TRA as an access site in a high-risk CS cohort.
Main Methods:
- A retrospective analysis of 7,231 CS patients from the British Cardiovascular Intervention database (2006-2012).
- Comparison of 30-day mortality and major adverse cardiac and cerebrovascular events (MACCE) between TFA (5,354 patients) and TRA (1,877 patients).
- Statistical analysis to determine the independent association of access site with outcomes.
Main Results:
- TRA was independently associated with significantly lower 30-day mortality (HR 0.56).
- TRA use correlated with reduced in-hospital MACCE (HR 0.64) and major bleeding (HR 0.37).
- These benefits were observed in a nonselected, high-risk patient population.
Conclusions:
- Despite TFA being more common, TRA is a viable and potentially safer alternative access site for PCI in CS patients.
- Experienced centers can successfully utilize TRA in this high-risk cohort, improving patient outcomes.
- The findings support wider consideration of TRA in cardiogenic shock management.
Background:
Cardiogenic shock (CS) remains the leading cause of mortality in patients hospitalized with acute myocardial infarction (AMI). The transradial access site (TRA) has become increasingly adopted as a default access site for percutaneous coronary intervention (PCI); however, even in experienced centers that favor the radial artery as the primary access site during PCI, patients presenting in CS are often treated via the transfemoral access site (TFA); and commentators have suggested that CS remains the final frontier that has given even experienced radial operators pause. We studied the use of TRA in patients presenting in CS in a nonselected high-risk cohort from the British Cardiovascular Intervention database over a 7-year period (2006-2012).
Methods:
Mortality (30-day) and major adverse cardiac and cerebrovascular events (a composite of in-hospital mortality, in-hospital myocardial reinfarction, target vessel revascularization, and cerebrovascular events) were studied based on TFA and TRA utilization in CS patients. The influence of access site selection was studied in 7,231 CS patients; TFA was used in 5,354 and TRA in 1,877 patients.
Results:
Transradial access site was independently associated with a lower 30-day mortality (hazard ratio [HR] 0.56, 95% CI 0.46-0.69, P = 0 < .001), in-hospital major adverse cardiac and cerebrovascular events (HR 0.64, 95% CI 0.53-0.76, P < .0001) and major bleeding (HR 0.37, 95% CI 0.18-0.73, P = .004).
Conclusions:
Although the majority of PCI cases performed in patients with cardiogenic shock in the United Kingdom are performed through the TFA, the radial artery represents an alternative viable access site in this high-risk cohort of patients in experienced centers.
