Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
Pol Arch Intern Med. 2021 May 25;131(5):421-428. doi: 10.20452/pamw.15886. Epub 2021 Mar 19.
The beneficial outcome of the radial (RA) over 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).
We sought to evaluate periprocedural outcomes of percutaneous coronary intervention (PCI) with RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI).
A total of 3,565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data was collected prospectively between 2014 and 2018 from 151 tertiary primary-PCI centers in Poland. To avoid possible selection bias, a propensity score matching (PSM) was used to create 945 matched pairs treated via RA or FA.
No differences were reported in baseline characteristics, clinical presentation and delays in treatment between RA and FA after the PSM. Similar radiation doses and the total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, RA was associated with reduced periprocedural mortality (9.4% (89) vs. 18.6% (176); P=0.001) and lower incidence of cardiac arrest (9.7% (92) vs. 16.1% (152); P=0.001). In multivariable analysis, FA was the strongest independent predictor for increased periprocedural mortality (OR 2.087, 95% CI 1.629-2.674; P=0.001).
The radial approach was associated with lower periprocedural mortality compared with FA in patients with STEMI complicated by CS. RA seems to be a valuable option in technically feasible situations.
经桡动脉（RA）入路在 ST 段抬高型心肌梗死（STEMI）中的有益结果已得到广泛证实。然而，大多数研究排除了合并心源性休克（CS）的 STEMI 患者。
我们旨在利用波兰全国经皮冠状动脉介入治疗（PCI）注册研究（ORPKI）的数据，评估经桡动脉和股动脉入路行直接 PCI 治疗合并 CS 的 STEMI 患者的围术期结局。
共纳入 3565 例因 STEMI 并发 CS 而行紧急 PCI 及支架植入术的连续患者。2014 年至 2018 年，在波兰的 151 家三级 PCI 中心前瞻性地收集数据。为了避免可能的选择偏倚，采用倾向评分匹配（PSM）法创建 945 对经 RA 或 FA 治疗的匹配对。
在 PSM 后，RA 与 FA 两组患者在基线特征、临床表现和治疗延迟方面无差异。两组的射线剂量和造影剂总量相似。两组围术期并发症发生率相似。但 RA 与较低的围术期死亡率（9.4%（89）比 18.6%（176）；P=0.001）和较低的心脏骤停发生率相关（9.7%（92）比 16.1%（152）；P=0.001）。多变量分析显示，FA 是围术期死亡率增加的最强独立预测因素（OR 2.087，95%CI 1.629-2.674；P=0.001）。
在合并 CS 的 STEMI 患者中，与 FA 相比，RA 与较低的围术期死亡率相关。在技术可行的情况下，RA 似乎是一种有价值的选择。
