Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France.
Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
Am Heart J. 2020 Jul;225:60-68. doi: 10.1016/j.ahj.2020.04.014. Epub 2020 Apr 30.
The use and impact of transradial artery access (TRA) compared to transfemoral artery access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) remain unclear.
This is a post hoc analysis of the CULPRIT-SHOCK trial where patients presenting with MI and multivessel disease complicated by CS were randomized to a strategy of culprit-lesion-only or immediate multivessel PCI. Arterial access was left at operator's discretion. Adjudicated outcomes of interest were the composite of death or renal replacement therapy (RRT) at 30 days and 1 year. Multivariate logistic models were used to assess the association between the arterial access and outcomes.
Among the 673 analyzed patients, TRA and TFA were successfully performed in 118 (17.5%) and 555 (82.5%) patients, respectively. Compared to TFA, TRA was associated with a lower 30-day rate of death or RRT (37.3% vs 53.2%, adjusted odds ratio [aOR]: 0.57; 95% confidence interval [CI] 0.34-0.96), a lower 30-day rate of death (34.7% vs 49.7%; aOR: 0.56; 95% CI 0.33-0.96), and a lower 30-day rate of RRT (5.9% vs 15.9%; aOR: 0.40; 95% CI 0.16-0.97). No significant differences were observed regarding the 30-day risks of type 3 or 5 Bleeding Academic Research Consortium bleeding and stroke. The observed reduction of death or RRT and death with TRA was no longer significant at 1 year (44.9% vs 57.8%; aOR: 0.85; 95% CI 0.50-1.45 and 42.4% vs 55.5%, aOR: 0.78; 95% CI 0.46-1.32, respectively).
In patients undergoing PCI for acute MI complicated by CS, TRA may be associated with improved early outcomes, although the reason for this finding needs further research.
经皮冠状动脉介入治疗（PCI）治疗急性心肌梗死（MI）合并心源性休克（CS）患者中，经桡动脉入路（TRA）与经股动脉入路（TFA）的应用和影响尚不清楚。
这是 CULPRIT-SHOCK 试验的事后分析，该试验中，MI 合并 CS 且多支血管病变的患者被随机分配至罪犯病变血运重建策略或即刻多支血管 PCI 策略。动脉入路由术者决定。主要终点为 30 天和 1 年时的死亡或肾脏替代治疗（RRT）复合终点。多变量逻辑回归模型用于评估动脉入路与结局之间的关系。
在分析的 673 例患者中，TRA 和 TFA 分别成功实施于 118 例（17.5%）和 555 例（82.5%）患者中。与 TFA 相比，TRA 患者 30 天死亡率或 RRT 发生率更低（37.3% vs 53.2%，调整后比值比 [aOR]：0.57；95%置信区间 [CI]：0.34-0.96），30 天死亡率更低（34.7% vs 49.7%；aOR：0.56；95% CI：0.33-0.96），30 天 RRT 发生率更低（5.9% vs 15.9%；aOR：0.40；95% CI：0.16-0.97）。TRA 组与 TFA 组 30 天的 3 型或 5 型出血学术研究联合会（BARC）出血和卒中发生率无显著差异。TRA 组在 1 年时死亡或 RRT 及死亡发生率的降低不再具有统计学意义（44.9% vs 57.8%，aOR：0.85；95% CI：0.50-1.45 和 42.4% vs 55.5%，aOR：0.78；95% CI：0.46-1.32）。
在接受 PCI 治疗的急性 MI 合并 CS 患者中，TRA 可能与早期结局改善相关，但需要进一步研究明确其原因。
