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Transradial Access vs. Transfemoral Access for Primary PCI in ST-Elevation Myocardial Infarction Complicated by
Minghui Zhang1, Zixu Zhao1, Yu Liu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Insights
Transradial access (TRA) reduces mortality in ST-elevation myocardial infarction with cardiogenic shock (STEMI-CS) patients undergoing percutaneous coronary intervention (PCI). This approach is safer and more effective than transfemoral access (TFA) for STEMI-CS, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Transradial access (TRA) is preferred for percutaneous coronary intervention (PCI) due to lower mortality and bleeding risks.
- Evidence for TRA in ST-elevation myocardial infarction with cardiogenic shock (STEMI-CS) is limited.
- This study addresses the efficacy and safety of TRA versus transfemoral access (TFA) in STEMI-CS patients.
Purpose of the Study:
- To evaluate the efficacy and safety of TRA compared to TFA for primary PCI in STEMI-CS.
- To determine if TRA offers improved outcomes in this high-risk patient population.
Main Methods:
- A nationwide, multicenter registry study compared TRA and TFA.
- Multivariable-adjusted Cox regression, propensity score matching, and inverse probability treatment weighting were used.
- Primary outcome: in-hospital all-cause mortality. Secondary outcomes: major bleeding and major adverse cardiovascular events (MACE).
- A meta-analysis of 17 studies (65,943 patients) was performed for short-term outcomes.
Main Results:
- TRA was associated with significantly lower in-hospital mortality (aHR, 0.62) and MACE (aHR, 0.63) compared to TFA in the registry data.
- Major bleeding risk was non-significantly lower with TRA (aHR, 0.72).
- Meta-analysis confirmed TRA's benefit: lower short-term mortality (OR, 0.50), major bleeding (OR, 0.58), and MACE (OR, 0.65).
Conclusions:
- Transradial access (TRA) is associated with reduced short-term all-cause mortality in STEMI-CS patients.
- These findings support the use of TRA as a potentially advantageous approach for primary PCI in STEMI-CS.
- TRA may offer improved safety and efficacy in this critical patient group.
Background And Objectives:
Transradial access (TRA) is recommended for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) due to lower mortality and bleeding risk, but evidence in STEMI with cardiogenic shock (STEMI-CS) remains limited. To evaluate the efficacy and safety of TRA versus transfemoral access (TFA) for primary PCI in STEMI-CS.
Methods:
Using data from a nationwide, multicenter registry, we compared TRA and TFA with multivariable-adjusted Cox regression, propensity score matching, and inverse probability treatment weighting. The primary outcome was in-hospital all-cause mortality. Other outcomes included major bleeding and major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiac arrest, reinfarction, stroke, or in-stent thrombosis. A meta-analysis was conducted to compare short-term outcomes of interest during hospitalization or within 30 days of hospital discharge.
Results:
Among 837 eligible patients, 669 underwent TRA. Multivariable Cox regression showed that TRA was associated with a lower risk of in-hospital mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.42-0.91), MACE (adjusted HR, 0.63; 95% CI, 0.43-0.91), but a non-significantly lower risk of major bleeding (adjusted HR, 0.72; 95% CI, 0.35-1.49) compared to TFA. Meta-analysis of 65,943 patients from 17 studies confirmed lower short-term mortality (odds ratio [OR], 0.50; 95% CI, 0.43-0.57), major bleeding (OR, 0.58; 95% CI, 0.48-0.71), and MACE (OR, 0.65; 95% CI, 0.53-0.80) with TRA.
Conclusions:
Our findings indicate that, in STEMI-CS, TRA is associated with lower short-term all-cause mortality compared with TFA, supporting the potential advantages of TRA in this population.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02306616.
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