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Radial approach reduces mortality in patients with ST-segment elevation myocardial infarction and cardiogenic shock
Tomasz Tokarek1, Artur Dziewierz2,3, Krzysztof Plens4
1Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland. tomek.tokarek@gmail.com
Insights
The radial approach (RA) reduced mortality and cardiac arrest rates in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). Femoral approach (FA) was linked to higher periprocedural mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Radial approach (RA) is favored over femoral approach (FA) for ST-elevation myocardial infarction (STEMI).
- Studies often exclude STEMI patients with cardiogenic shock (CS).
Purpose of the Study:
- Evaluate periprocedural outcomes of RA versus FA in STEMI patients with CS undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Propensity score matching (PSM) used on 3,565 STEMI patients with CS from the Polish National PCI Registry (ORPKI).
- Created 945 matched pairs for RA and FA groups.
- Data collected prospectively from 2014-2018.
Main Results:
- No significant differences in baseline characteristics, clinical presentation, treatment delays, radiation dose, or contrast volume between RA and FA.
- Similar periprocedural complication rates observed.
- RA associated with significantly lower periprocedural mortality (9.4% vs. 18.6%) and cardiac arrest incidence (9.7% vs. 16.1%).
- FA identified as an independent predictor of increased periprocedural mortality (OR 2.087).
Conclusions:
- Radial approach (RA) demonstrates superior outcomes compared to femoral approach (FA) in STEMI patients with cardiogenic shock (CS).
- RA is a valuable alternative in technically feasible cases for this high-risk population.
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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