Cardiogenic shock and access site choice

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Transradial access (TRA) utilization is increasing, but its use in patients with cardiogenic shock (CS) remains limited.
• Existing literature comparing TRA and transfemoral access (TFA) in CS patients is scarce, with some studies excluding this population.
• Operators have shown reluctance to adopt TRA for CS patients despite growing experience.

Purpose of the Study:

• To review and critically examine the existing literature on outcomes of percutaneous coronary intervention (PCI) in CS patients using TRA versus TFA.
• To compile and analyze data from various datasets, including non-published details, focusing on CS patients.

Main Methods:

• Systematic review and critical examination of published and non-published data from datasets comparing TRA and TFA in CS patients undergoing PCI.
• Detailed description and analysis of study populations, methodologies, and conclusions of included studies.
• Focus on access-site related outcomes in CS patients.

Main Results:

• Observational data suggests a composite outcome favoring TRA over TFA in CS patients undergoing PCI.
• A significant selection bias exists, with sicker CS patients often being triaged to TFA, complicating direct comparisons.
• Some high-quality adjusted analyses indicate better outcomes with TRA in this patient group.

Conclusions:

• While current observational data suggests potential benefits of TRA in CS patients undergoing PCI, interpretation is limited by selection bias.
• There is a clear and immediate need for a well-powered randomized trial to definitively evaluate the efficacy and safety of TRA versus TFA in CS patients.
• Further research is crucial to guide optimal vascular access strategies for patients with cardiogenic shock.