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

INTRODUCTION

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).

OBJECTIVES

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).

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.