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Prognosis Impact and Prediction of Trans-Radial Access Failure in Patients With STEMI, A Nationwide Observational
Dániel Tornyos1, Réka Lukács1, András Jánosi2
1Heart Institute, Medical School, University of Pécs, Pécs, Hungary.
Successful trans-radial access (TRA) improves outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Failed TRA is linked to higher mortality and adverse events, with current prediction models not outperforming the GRACE 2.0 score.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Trans-radial access (TRA) is the preferred arterial approach for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI).
- Failure of TRA necessitates crossover to trans-femoral access, but the prognostic implications and predictive modeling for TRA failure in STEMI patients remain unclear.
Purpose of the Study:
- To evaluate the impact of failed TRA on 1-year mortality and major adverse cardiovascular events (MACE) in STEMI patients.
- To assess the utility and performance of predictive models, including machine learning techniques, for TRA failure in STEMI.
- To compare the predictive performance of novel models against established scores like the GRACE 2.0 score.
Main Methods:
- Analysis of data from the Hungarian Myocardial Infarction Registry (2014-2020) including 76,625 STEMI patients.
- Propensity score matching to compare outcomes between successful TRA (33,573) and failed TRA (720) groups.
- Cox regression for prognostic impact and machine learning for TRA failure prediction, with comprehensive model evaluation.
Main Results:
- Failed TRA was associated with significantly higher 1-year mortality (34.3% vs 22.5%) and MACE (37.4% vs 26.8%) compared to successful TRA, even after risk adjustment.
- Door-to-balloon time did not significantly differ between successful and failed TRA groups.
- Regularized Discriminant Analysis showed promise for TRA failure prediction (AUC: 0.66), but the GRACE 2.0 score demonstrated comparable performance (AUC: 0.65) with better sensitivity.
Conclusions:
- Successful TRA is crucial for optimizing patient outcomes in STEMI, and failure is independently linked to poorer prognosis.
- Current clinical prediction models for TRA failure do not surpass the predictive capability of the GRACE 2.0 score.
- The GRACE 2.0 score remains a relevant tool for clinical decision-making in STEMI patients undergoing PCI.
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