Radial approach reduces mortality in patients with st-segment elevation myocardial infarction and cardiogenic shock

Abstract

Introduction The beneficial outcome of the radial approach (RA) over the 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 the RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI). Patient s and methods A total of 3565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data were collected prospectively from 151 tertiary invasive cardiology centers performing primaryPCI in Poland between 2014 and 2018. To avoid possible selection bias, propensity score matching was used to create 945 matched pairs treated via the RA or FA. Result s No differences were reported in baseline characteristics, clinical presentation, and delays in treatment between the RA and FA after propensity score matching. Similar radiation doses and total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, the RA was associated with reduced periprocedural mortality (89 [9.4%] vs 176 [18.6%]; P = 0.001) and lower incidence of cardiac arrest (92 [9.7%] vs 152 [16.1%]; P = 0.001). The FA was the strongest independent predictor of increased periprocedural mortality in the multivariable analysis (odds ratio, 2.087; 95% CI, 1.629-2.674; P = 0.001). Conclusions The RA was associated with lower periprocedural mortality compared with the FA in patients with STEMI complicated by CS. The RA seems to be a valuable option in technically feasible situations.