Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Oxford Road, Manchester, United Kingdom.
Am Heart J. 2014 Jun;167(6):900-8.e1. doi: 10.1016/j.ahj.2014.03.007. Epub 2014 Mar 27.
Cardiogenic shock (CS) remains the leading cause of mortality in patients hospitalized with acute myocardial infarction (AMI). The transradial access site (TRA) has become increasingly adopted as a default access site for percutaneous coronary intervention (PCI); however, even in experienced centers that favor the radial artery as the primary access site during PCI, patients presenting in CS are often treated via the transfemoral access site (TFA); and commentators have suggested that CS remains the final frontier that has given even experienced radial operators pause. We studied the use of TRA in patients presenting in CS in a nonselected high-risk cohort from the British Cardiovascular Intervention database over a 7-year period (2006-2012).
Mortality (30-day) and major adverse cardiac and cerebrovascular events (a composite of in-hospital mortality, in-hospital myocardial reinfarction, target vessel revascularization, and cerebrovascular events) were studied based on TFA and TRA utilization in CS patients. The influence of access site selection was studied in 7,231 CS patients; TFA was used in 5,354 and TRA in 1,877 patients.
Transradial access site was independently associated with a lower 30-day mortality (hazard ratio [HR] 0.56, 95% CI 0.46-0.69, P = 0 < .001), in-hospital major adverse cardiac and cerebrovascular events (HR 0.64, 95% CI 0.53-0.76, P < .0001) and major bleeding (HR 0.37, 95% CI 0.18-0.73, P = .004).
Although the majority of PCI cases performed in patients with cardiogenic shock in the United Kingdom are performed through the TFA, the radial artery represents an alternative viable access site in this high-risk cohort of patients in experienced centers.
心原性休克（CS）仍然是急性心肌梗死（AMI）住院患者死亡的主要原因。经桡动脉入路（TRA）已越来越多地被用作经皮冠状动脉介入治疗（PCI）的默认入路；然而，即使在那些在 PCI 中首选桡动脉作为主要入路的经验丰富的中心，CS 患者通常也通过股动脉入路（TFA）进行治疗；评论员认为 CS 仍然是经验丰富的桡动脉操作者犹豫不决的最后一个领域。我们在英国心血管介入数据库的 7 年期间（2006-2012 年），对非选择性高危队列中出现 CS 的患者进行了 TRA 的使用研究。
根据 CS 患者 TFA 和 TRA 的使用情况，研究死亡率（30 天）和主要不良心脏和脑血管事件（住院期间死亡率、再梗死、靶血管血运重建和脑血管事件的复合事件）。研究了 7231 例 CS 患者的入路选择的影响；TFA 用于 5354 例患者，TRA 用于 1877 例患者。
TRA 与 30 天死亡率降低独立相关（风险比 [HR] 0.56，95%置信区间 [CI] 0.46-0.69，P <.001），住院期间主要不良心脏和脑血管事件（HR 0.64，95%CI 0.53-0.76，P <.0001）和大出血（HR 0.37，95%CI 0.18-0.73，P =.004）。
尽管在英国，大多数在 CS 患者中进行的 PCI 病例都是通过 TFA 进行的，但在经验丰富的中心，桡动脉在这个高危患者群体中是另一种可行的入路。
