Schoenfeld Matthew S, Kassas Ibrahim, Shah Binita
New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA.
VA New York Harbor Healthcare System, Manhattan Campus, New York University School of Medicine, 423 E 23rd Street, Room 12023-W, New York, NY, 10010, USA.
Curr Treat Options Cardiovasc Med. 2018 Feb 24;20(2):11. doi: 10.1007/s11936-018-0607-1.
Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.
早期血运重建是ST段抬高型心肌梗死（STEMI）合并心源性休克（CS）患者治疗的金标准。近年来，经桡动脉途径（TRA）在经皮冠状动脉介入治疗（PCI）中的应用有所增加，并已成为高危患者PCI的一种安全有效的方法，与经股动脉途径（TFA）相比，在减少主要出血事件、其他围手术期并发症和全因死亡率方面具有优势。多项随机临床试验已证明TRA与TFA PCI在STEMI患者中的这些优势。尽管CS患者仍缺乏专门的随机试验，但观察性数据表明，TRA与TFA PCI相比，在CS患者中对相同终点有获益。本综述总结了关于STEMI和CS患者使用TRA与TFA相比的现有文献；TRA在STEMI和CS中减少主要出血事件、其他围手术期并发症和死亡率的情况；以及这些高危患者群体护理中的技术考虑因素和挑战。
