Hasun Matthias, Dörler Jakob, Alber Hannes F, Bauer Axel, Berger Rudolf, Christ Günter, Frick Matthias, Hoppe Uta C, Huber Kurt, Lamm Gudrun, Laßnig Elisabeth, von Lewinski Dirk, Rab Anna, Roithinger Franz X, Schuchlenz Herwig, Siostrzonek Peter, Sipötz Johann, Stefenelli Thomas, Steinwender Clemens, Edlinger Michael, Weidinger Franz
2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria.
Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria.
Cardiovasc Diagn Ther. 2021 Jun;11(3):726-735. doi: 10.21037/cdt-20-977.
Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice.
For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access.
Radial compared to femoral access was associated with lower in-hospital mortality (3.5% 7.7%; P<0.01). Multivariable logistic regression analysis confirmed reduced in-hospital mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.43 to 0.75]. Furthermore, MACE (OR 0.60, 95% CI: 0.47 to 0.78) as well as NACE (OR 0.59, 95% CI: 0.46 to 0.75) occurred less frequently in patients with radial access. Interaction analysis with cardiogenic shock showed an effect modification, resulting in lower mortality in PCI via radial access in patients without, but no difference in those with cardiogenic shock (OR 1.78, 95% CI: 1.07 to 2.96).
Radial access for patients with acute MI undergoing PPCI is associated with improved survival in a large contemporary cohort of daily practice. However, this beneficial effect is restricted to hemodynamically stable patients.
随机对照试验显示，在接受直接经皮冠状动脉介入治疗（PPCI）的患者中，桡动脉入路的结果各不相同。此外，对于心源性休克患者接受PPCI时，桡动脉入路是否能改善预后也存在疑问。我们旨在调查在日常临床实践中，有或无心源性休克患者根据入路部位的预后情况。
在本次分析中，我们纳入了2012年至2018年间在多中心、全国性心肌梗死（MI）PCI登记处登记的9980例接受PPCI的患者。比较了4498例采用桡动脉入路（45%）和5482例采用股动脉入路（55%）患者的院内死亡率、主要不良心血管事件（MACE）和出院前净不良临床事件（NACE）。
与股动脉入路相比，桡动脉入路与较低的院内死亡率相关（3.5%对7.7%；P<0.01）。多变量逻辑回归分析证实院内死亡率降低[比值比（OR）0.57，95%置信区间（CI）：0.43至0.75]。此外，采用桡动脉入路的患者发生MACE（OR 0.60，95%CI：0.47至0.78）和NACE（OR 0.59，95%CI：0.46至0.75）的频率较低。与心源性休克的交互分析显示存在效应修正，导致无心源性休克患者经桡动脉入路进行PCI时死亡率较低，但有心源性休克患者无差异（OR 1.78，95%CI：1.07至2.96）。
在当代大量日常实践队列中，急性心肌梗死患者接受PPCI时采用桡动脉入路与生存率提高相关。然而，这种有益效果仅限于血流动力学稳定的患者。
