• Pol. Arch. Med. Wewn. · May 2021

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

    • Tomasz Tokarek, Artur Dziewierz, Krzysztof Plens, Tomasz Rakowski, Dariusz Dudek, and Zbigniew Siudak.
    • Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland. tomek.tokarek@gmail.com
    • Pol. Arch. Med. Wewn. 2021 May 25; 131 (5): 421-428.

    IntroductionThe 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).ObjectivesWe 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 MethodsA 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.ResultsNo 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).ConclusionsThe 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.

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